Penny Allen

With marijuana legalized for medical use in Canada since 2001 and now in 17 U.S. states and the District of Columbia, urology patients in pain have been turning to marijuana for relief.

Nearly as many American men as women may suffer from interstitial cystitis/bladder pain syndrome (IC/BPS) symptoms. And more men may have IC/BPS symptoms than have chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) symptoms, new data suggest.

Neurotrophic factors that appear in interstitial cystitis/bladder pain syndrome (IC/BPS) patients' urine and disappear with onabotulinumtoxinA (Botox) treatment point to peptidergic primary bladder afferent nerves as the root of patients' pain and other symptoms.

For years, some urologists and physical therapists have been saying that the pelvic floor is contracted and shortened because of hypertonicity in patients with interstitial cystitis/painful bladder syndrome (IC/PBS), contributing to their misery. Now, using magnetic resonance imaging measurements, researchers have some physical confirmation that these patients do indeed have a contracted pelvic floor.

A study on onabotulinumtoxinA (Botox) injection into the trigone in Interstitial cystitis/bladder pain syndrome patients threw some doubt on whether Hunner's lesions themselves are the major pain generators, even though the study was not designed for that purpose.

In just 18 patients, a multicenter phase Ib trial of an intravesical lidocaine-delivery device, called LiRIS (lidocaine-releasing intravesical system), not only knocked down pain and other symptoms for the 2 weeks the device was in the bladders of severely symptomatic patients, but in addition, the effects lasted 4 weeks and longer for many patients.

Already approved for neurogenic overactive bladder, onabotulinumtoxinA (Botox) may now be on its way to garnering an indication for idiopathic OAB.

Signs of the sea change to come in the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) will be part of the 2012 AUA annual meeting. Next year should bring even more, as the National Institute of Diabetes and Digestive and Kidney Diseases and pharma research get readied for meeting debuts.

Nerve growth factor (NGF) levels in urine could prove a useful biomarker for interstitial cystitis/painful bladder syndrome (IC/PBS) and neurogenic overactive bladder.

A multicenter Japanese team has proposed a method for approaching infection prophylaxis with prostate biopsy patients.

Early results with tanezumab (RN624), an investigational monclonal antibody against nerve growth factor, show promise for chronic bladder pain in interstitial cystitis.

A vaccine against urinary tract infection is a step closer to reality in the United States.

Alpha-blockers, tricyclic antidepressants, or both can improve compliance, lower pressures at bladder capacity, and improve reflux, incontinence, and detrusor overactivity in neurogenic bladder patients.

Botulinum toxin A is proving to be valuable for relief of interstitial cystitis.

Nerve growth factor levels in urine could prove a useful biomarker for interstitial cystitis/painful bladder syndrome and neurogenic overactive bladder.

Despite bringing lower rates of positive surgical margins and lower PSA nadirs, long-term neoadjuvant hormonal therapy did not lead to a difference in rates of PSA recurrence after 7 years.

Different areas of the brain are active in different chronic pain conditions, and now researchers have shown that those areas are distinctly different in patients with interstitial cystitis and chronic prostatitis/chronic pelvic pain syndrome.

Men with CP/CPPS who responded to treatment in two trials reported better quality of life, particularly physical quality of life, and better sexual functioning.

Combination of an immunofluorescence test and cytology may improve quality of bladder cancer diagnostics.

For the first time in years, patients with interstitial cystitis, especially those with the worst cases, may have an effective new treatment.

Interstitial cystitis biomarkers didn't change with long-term neuromodulation in a surprising study.

Bethesda, MD-Concepts of what interstitial cystitis is, what causes it, and how to treat it are changing. That was apparent with the tremendous infusion of new ideas from many specialties here at the 2006 International Symposium: Frontiers in Painful Bladder Syndrome and Interstitial Cystitis, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. Whether those concepts can change without changing the name of the disease, however, was a hotly debated question.

Atlanta-Minimally invasive slings can work in women with stress urinary incontinence, even after a sling has failed. A key to success may be a higher presurgical Valsalva leak-point pressure.

Atlanta-Will patients with stage I nonseminomatous testicular cancer (NSGCT) do better with one course of chemotherapy than with retroperitoneal lymph node dissection (RPLND)? That's what the results of a large, long-term German study implied, but some have sounded a note of caution, wanting longer and better follow-up before recommending any first-line therapy other than rigorous surveillance. The answer may depend on the care that will work best in the community, rather than on the care available at specialized centers.

Atlanta-Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has a huge impact on men's sexuality, but a combination of pelvic muscle trigger point release physiotherapy and relaxation training can go a long way toward improving sexual dysfunction in these men, said Rodney U. Anderson, MD, professor of urology, Stanford University School of Medicine, Stanford, CA.

Atlanta-Urologists can add one more alternative, plant-based medication to the list of intriguing possibilities for treating urologic disease. This one is a rye-pollen extract called Cernilton that showed promising results in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in a preliminary, placebo-controlled study from Germany.

Atlanta-Direct medical costs are nearly twice as much for men with chronic prostatitis as men without, and those costs are definitely because of the disease, an analysis of an HMO's cost data showed.

Atlanta-Bisphosphonates have already been shown to reduce loss of bone mineral density (BMD) in men undergoing androgen deprivation therapy and to reduce skeletal events and markers of bone turnover in men with metastatic prostate cancer. However, the drugs carry risks and can be expensive. That's why Dror Michaelson, MD, PhD, an assistant in medicine at Massachusetts General Hospital and instructor at Harvard Medical School, Boston, examined the effects of zoledronic acid (Zometa) in a once-annual dosing schedule that is much reduced compared with that used in past trials.

Atlanta-Based on the landmark TAX-327 study, which showed a survival benefit of treatment every 3 weeks with docetaxel (Taxotere)/prednisone over mitoxantrone hydrochloride/prednisone, the every-3-weeks docetaxel regimen has now become a standard of care for men with metastatic hormone-refractory prostate cancer.

Atlanta-Like intermittent androgen deprivation, could intermittent chemotherapy give men with prostate cancer welcome treatment holidays and still control cancer?