Smith Blog

Marina Ruzimovsky led a superb Pelvic Pain Support Group on February 28th.

Topics discussed included…

*The male chronic prostatitis/chronic patient: current management strategies

*New concepts of patient evaluation: Examination of the multiple facets of patient presentation (co-morbid conditions) rather than just the bladder or prostate.

*Novel and evolving approaches to the treatment of pelvic pain
The role of…
Cannabanoids
Liposomes
Nerve Growth Factor Immunoglobulin (Tanezumab)
Physical Therapy
Posterior tibial nerve stimulation
Trigger point injections
Botulinum toxin injections
New bladder instillations
Medications that can be administered through the vagina or rectum
Neuromodulation
Interferential transcutaneous nerve stimulation (iTENS)
Diet changes

* Two new studies for Interstitial Cystitis patients were discussed

-Caffeine study. Interstitial cystitis patients who feel that they are “coffee sensitive” are encouraged to participate. The project is designed to determine whether caffeine is actually the cause of IC related symptoms. If interested in participating, please contact Dr. Sadek (516) 734-8565.

-Nerve growth factor Immunoglobulin study (Tanezumab) for Interstitial Cystitis.  This is a study which will likely start in May 2010. For more information, please contact Monica Johnson, RN, our new clinical research coordinator, (516) 734-8515.

The American Urological Association Annual meeting in Chicago (April 25th – April 30th) was a huge success for patients suffering from pelvic pain. Some of the latest news…

1.    Various differences may exist in urinary protein expression between interstitial cystitis (IC) patients and those without IC. This suggests that “urinary proteomics” may provide insight into the cause of IC and/or aid in the development of new “markers” for this condition.
2.    Nerve growth factor was found to be elevated in the urine of IC patients and in patients with overactive bladder and even in patients with varied lower urinary tract symptoms.
3.    Patients with IC appear to have significant biosocial impairment as compared to the population at large. Also, conditions such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome were more frequently seen in the IC population.
4.    The Rand Interstitial Cystitis Epidemiology study evaluated almost 100,000 US households and found the prevalence of IC type symptoms in women to be 3-6%, a significantly higher prevalence than previous studies. This suggests that IC symptoms may exist in over 4 million women in the United States!
5.    Botulinum toxin A (100 units) into the bladder base (trigone) improved the symptoms of all 17 patients in one study. At 9 months follow up, 7 patients requested another injection due to return of symptoms.
6.    In another Botulinum toxin A related study, Botulinum toxin A appeared to enhance the clinical effect of bladder hydrodistention.
7.    Antiproliferative factor (APF) is a chemical found in the urine of most IC patients and may be a cause of symptoms. Two new agents have shown promise as APF inhibitors in the laboratory setting.
8.    Both IC patients and patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) had a high prevalence of food sensitivities, but IC patients still had about twice the prevalence as the CP/CPPS patients.
9.     A clinical phenotyping system termed “UPOINT” (Urinary, Psychosocial, Organ specific, Infection, Neurologic/Systemic, Tenderness of pelvic floor muscles) was developed to better understand the cause of and best therapies for CP/CPPS.
10.    In a randomized, double blinded study, pregabalin (Lyrica®)  was not found to be better than a placebo group in the treatment of CP/CPPS…BUT..when evaluating “secondary endpoints” such as global improvements, significant differences where found, suggesting a role for this medication in the treatment of CP/CPPS.

For this information and more, please visit the Pelvic Pain section of this website.

Robert Moldwin, MD
Associate Professor of Clinical Urology
Hofstra University School of Medicine
Director, Pelvic Pain Center
The Arthur Smith Institute for Urology
Long Island Jewish Medical Center