Buffington: "A Watershed Year for Interstitial Cystitis"

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kevin
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Buffington: "A Watershed Year for Interstitial Cystitis"

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A Watershed Year for Interstitial Cystitis
C.A. Tony Buffington
The Journal of Urology
DOI: 10.1016/j.juro.2009.12.061
Would be interesting if anyone has access to this article. I'm curious what "watershed" Dr. Buffington is referring to.
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy; pubic/prostate/perineal discomfort; Helped by: trigger point therapy, Afrin nasal spray, Cymbalta, hydrocodone (small doses), distraction. Makes worse: sex.

Not medical advice. Consult your doctor.
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webslave
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Re: Buffington: "A Watershed Year for Interstitial Cystitis"

Post by webslave »

May be worth emailing Tony. I've found him very approachable in the past.
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Re: Buffington: "A Watershed Year for Interstitial Cystitis"

Post by gmccormack »

I have spoken to him before as well, great guy. I got the article but now it's saying "the extension PDF is not allowed" do I need special user privelages to post this?
Age: | Onset Age: | Symptoms: | Helped By: | Worsened By: | Other comments:
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Re: Buffington: "A Watershed Year for Interstitial Cystitis"

Post by webslave »

Email it to me, if you can. I will be able to do something with it.
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Re: Buffington: "A Watershed Year for Interstitial Cystitis"

Post by webslave »

A Watershed Year for Interstitial Cystitis

A watershed is occurring in our understanding of interstitial cystitis (IC). Recent publications in The Journal of Urology® and others have added expla­nations of genetic1 and epigenetic2 influences, docu­mented the time course of the appearance of comor­bid disorders3 and shown again how much systemic involvement occurs in most patients.4

A disorder once described as “a hole in the air” may be yielding to investigators looking beyond the bladder to consider the whole individual. The most recent contributions to this expanded view of IC as a problem affecting the bladder rather than as a bladder problem include contributions to an expanded view of phenotyping of IC cases. A recent group concluded, “(Clinically relevant) do­mains that function outside of the bladder (psy­chosocial, neurological, tenderness) predict a sig­nificant impact on symptoms.”4 A new review added additional evidence for an overlap between urological and nonurological unexplained clinical conditions.5

The article by Ogawa et al (page 000) in this issue of The Journal focuses on the ulcerative form of IC, which may be different from the nonulcer­ative form in its extent of systemic involvement. Although their gene expression studies are limited to urothelium, others have reported increased cir­culating chemokines in patients with IC.6

Concurrent events also are under way at the National Institute of Diabetes, Digestive and Kid­ney Diseases (NIDDK), which recently established the Multidisciplinary Approach to the Study of Chronic Pelvic Pain research network. The network is charged to take a new look at urological chronic pelvic pain and is undertaking comprehensive phenotyping activi­ties in patients with these syndromes. Another recently reported systemic biomarker may even­tually assist in diagnosing IC in humans and animals.7

However, new knowledge cannot always be ac­cepted and integrated easily. For example, revi­sion of the nosology of the syndrome has been under way for some time. Although IC no longer captures the extent of the problem, if it ever did, it is less clear what the most appropriate name may be. A number of suggestions have been offered, including painful bladder syndrome, bladder pain syndrome and bladder hypersensitivity syndrome. They remain focused on the end organ, still re­flecting the perspective of the specialty rather than current understanding of the syndrome. Feinstein recently concluded, “An important prin­ciple in naming apparently new ailments is to avoid etiologic titles until the etiologic agent has been suitably demonstrated. A premature causal name can impair a patient’s recovery from the syndrome and impede research that may find the true cause.”8 Regardless of the name eventually chosen, we have reached a time when the descrip­tion of patients with IC (and these 2 letters may be name enough for the time being) in research and clinical presentations and publications may no longer be restricted to urinary symptoms.

A research implication of this new view is the choice of appropriate animal models for studying IC. Acute bladder injury in otherwise healthy an­imals cannot adequately model the systemic as­pects of IC. Fortunately various models in other disciplines are available that exploit the effects of early adverse experience on adult physiology and behavior.9 Although to my knowledge reports of the effects of these maneuvers on voiding function have not yet appeared, the results of evaluating other organs suggest that isolated abnormalities are unlikely. Collaboration with groups that have established these models could rapidly screen for influences on bladder function using relatively simple methods.

What has also occurred recently is the retire­ment of a major driving force behind this renais­sance of knowledge about IC, Dr. Lee Nyberg. Leroy M. Nyberg, M.D. and Ph.D., was Director of Urology Programs at NIDDK from 1989 until re­tirement in September 2009. His portfolio in­cluded directing basic and clinical research into IC, and he led NIDDK efforts to understand its etiopathogenesis. Doctor Nyberg was instrumen­tal in developing research programs, mentoring and collaborating with investigators, and speaking at conferences around the world about IC. As an indicator of his influence, there were 317 IC citations in PubMed® from 1929 to the end of 1989 and from 1989 to the end of 2009 a total of 1,678 were added (53 vs 839 per decade), a 16-fold in­crease. Because of his efforts and those of many others, new leaders in IC research and treatment will emerge. They and their patients have Doctor Nyberg’s determination and persistence to thank for getting us to this new place in the evolution of our understanding of IC.

C. A. Tony Buffington
Veterinary Clinical Sciences Department of Urology The Ohio State University Veterinary Hospital Columbus, Ohio

REFERENCES
1. Dimitrakov J and Guthrie D: Genetics and pheno­typing of urological chronic pelvic pain syndrome. J Urol 2009; 181: 1550.
2. Buffington CAT: Developmental influences on med­ically unexplained symptoms. Psychother Psycho­som 2009; 78: 139.
3. Warren JW, Howard FM, Cross RK et al: Anteced­ent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome. Urol­ogy 2009; 73: 52.
4. Nickel JC, Shoskes D and Irvine-Bird K: Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome: a key to classification and potentially improved management. J Urol 2009; 182: 155. 5. Rodriguez MA, Afari N and Buchwald DS: Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol 2009; 182: 2123.
6. Sakthivel SK, Singh UP, Singh S et al: CXCL10 blockade protects mice from cyclophosphamide­induced cystitis. J Immune Based Ther Vaccines 2008; 6: 6.
7. Rubio-Diaz DE, Pozza ME, Dimitrakov J et al: A candidate serum biomarker for bladder pain syn­drome/interstitial cystitis. Analyst 2009; 134: 1133.
8. Feinstein AR: The blame-X syndrome: problems and lessons in nosology, spectrum, and etiology. J Clin Epidemiol 2001; 54: 433.
9. Barreau F, Ferrier L, Fioramonti J et al: New insights in the etiology and pathophysiology of irritable bowel syndrome: contribution of neonatal stress models. Pediatr Res 2007; 62: 240.



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kevin
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Re: Buffington: "A Watershed Year for Interstitial Cystitis"

Post by kevin »

Thanks Webslave/gmccormack. Not too much in the article we weren't already aware of, but I agree that there has been an encouraging paradigm shift in recent years about the way IC/CPPS is viewed.
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy; pubic/prostate/perineal discomfort; Helped by: trigger point therapy, Afrin nasal spray, Cymbalta, hydrocodone (small doses), distraction. Makes worse: sex.

Not medical advice. Consult your doctor.
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