Table 4 Upoint Dr. Robert Evans (Wake Forest University, Winston-Salem, NC) presented the list and evidence for the bladder-based therapy of UCPPS (IC/BPS) using the grading of recommendations from the recent AUA guidelines. These are listed in Table 5. Table 5 Evidence for Bladder-based
Therapy of Urologic Chronic Pelvic Pain Syndrome Dr. Evans broke down bladder-specific therapy into those directed MLN8237 toward mechanistic Inhibitors,research,lifescience,medical categories (Table 6). Intravesical therapies include variations of DMSO, heparin, lidocaine, and sodium bicarbonate. He discussed the impact of hydrodistension, which can be short lived. Combining that with fulguration of Hunner’s lesions can result in significant, but again temporary, amelioration of symptoms. Table 6 Mechanistic Categories of Bladder-specific Therapy Dr. Christopher K. Payne (Stanford University, Stanford, CA) urged the audience to consider pelvic floor physical therapy for men and women with UCPPS. He demonstrated that pelvic floor dysfunction is very prevalent Inhibitors,research,lifescience,medical in patients with chronic pelvic pain and that focused pelvic Inhibitors,research,lifescience,medical floor physiotherapy has been shown to be effective in case series as well as sham-controlled studies. The physical examination of the pelvis is key to the diagnosis and subsequent successful therapy; urologists should
make an effort to determine pelvic floor tone, pain, and painful trigger points. They should find a local physiotherapist who has been trained in this specialized type of physiotherapy. Dr. Payne stressed that physiotherapy can and should be used with other therapies directed toward other phenotypes associated with Inhibitors,research,lifescience,medical UCPPS. Follow-up and reassessment is important, not only for patients referred to physiotherapy, but for all patients diagnosed and
treated by urologists for this condition. Dr. Claire Yang, MD (University of Washington, Seattle, WA), described neuromodulation therapy—the electrical stimulation of a nerve, spinal cord, or brain in order to change the nerve activity. Dr. Yang stressed that neuromodulatory therapy for CPPS is not a standard treatment and should only be considered after other traditional Inhibitors,research,lifescience,medical treatments have failed. With neuromodulation, signals are introduced through the nerves to either overcome the pain signals Non-specific serine/threonine protein kinase or divert them. They somehow alter the way that the brain is processing the pain signals so that it doesn’t perceive them as pain or it doesn’t perceive them as strongly. The literature on the use of neuro-modulation suggests that it might play a role in the amelioration of UCPPS symptoms (particularly urinary symptoms for which it has an indication) in patients who have not responded to more traditional approaches of therapy. In a case-based panel discussion moderated by Dr. Nickel, the panelists expanded on how to differentiate between the various phenotypes in clinical practice, and how to strategically use the therapies described. This panel discussion is available on the AUA 2012 Annual Meeting Web site.