REVIEW OF THE INTERNATIONAL CONTINENCE SOCIETY (ICS) ANNUAL SCIENTIFIC MEETING RIO DE JANEIRO, BRAZIL, 20-24 October 2014

5 INVESTIGATION OF AN ACUTE ROLE FOR NON-NEURONAL CELLS IN PELVIC PAIN AND BLADDER DYSFUNCTION IN A NOVEL MOUSE MODEL OF EXPERIMENTAL AUTOIMMUNE CYSTITIS (EAC). Bicer F, Huang W, Daneshgari F, Hanna-Mitchell A. This study group from Cleveland reported that the underlying pathophysiology of PBS/IC is poorly understood and, unfortunately for millions of patients suffering from this debilitating disease, therapeutic strategies for treatment have failed to produce clinically significant results. Characterizing the impact of urothelium-directed autoimmunity on urothelial and spinal cord glial (microglia and astrocytes) physiology will provide valuable mechanistic information about the underlying pathophysiology of PBS/IC and provide a new perspective on clinical management of this chronic pain syndrome. Abstract #13 FACTORS THAT AFFECT THE TREATMENT OF REFRACTORY INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME USING INTRAVESICAL THERAPY WITH A HYALURONIC ACID SOLUTION: RESULTS FROM A PROSPECTIVE MULTICENTER STUDY ON 103 PATIENTS. Hung M. Intravesical therapy with a hyaluronic acid (HA) solution is an effective treatment for IC/BPS, however with13 FACTORS THAT AFFECT THE TREATMENT OF REFRACTORY INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME USING INTRAVESICAL THERAPY WITH A HYALURONIC ACID SOLUTION: RESULTS FROM A PROSPECTIVE MULTICENTER STUDY ON 103 PATIENTS. Hung M. Intravesical therapy with a hyaluronic acid (HA) solution is an effective treatment for IC/BPS, however with varying degrees of success. This was a prospective multicentre study from Taiwan that aimed to evaluate factors that may have associations with treatment outcomes. They found that intravesical HA is an effective and safe treatment for refractory IC/BPS. However, according to this study, the treatment seems to be more effective in reducing bladder pain compared to urinary symptoms. Those patients who reported lower pain scores and reduced functional bladder capacity before treatment may have sub-response to the treatment. Abstract #14 A RANDOMIZED, OPEN-LABEL, MULTICENTRE STUDY OF EFFICACY AND SAFETY OF INTRAVESICAL HYALURONIC ACID AND CHONDROITIN SULFATE (HA 1.6% AND CS 2%) VS. DIMETHYL SULFOXIDE (DMSO 50%) IN WOMEN WITH BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS (BPS/IC). Cervigni M, Sommariva M, Porru D3, Ostardo E, Tenaglia R, Giammò A, Pappagallo G. The aim of this study from Italy was to evaluate the efficacy and safety of intravesical instillations with high concentration HA 1.6% and CS 2.0% versus DMSO 50% in female patients with diagnosis of BPS/IC. While at the-end-of-treatment visit, the response to treatment in terms of pain decrease from baseline was statistically14 A RANDOMIZED, OPEN-LABEL, MULTICENTRE STUDY OF EFFICACY AND SAFETY OF INTRAVESICAL HYALURONIC ACID AND CHONDROITIN SULFATE (HA 1.6% AND CS 2%) VS. DIMETHYL SULFOXIDE (DMSO 50%) IN WOMEN WITH BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS (BPS/IC). Cervigni M, Sommariva M, Porru D3, Ostardo E, Tenaglia R, Giammò A, Pappagallo G. The aim of this study from Italy was to evaluate the efficacy and safety of intravesical instillations with high concentration HA 1.6% and CS 2.0% versus DMSO 50% in female patients with diagnosis of BPS/IC. While at the-end-of-treatment visit, the response to treatment in terms of pain decrease from baseline was statistically significant in both groups, there was a higher proportion of patients with adverse events in the DMSO (30.56%) than in the HA/CS (14.86%) group. The results from voiding diaries and the questionnaire scores were consistent with pain reduction. They concluded that on the basis of their results, treatment with intravesical instillations of HA/CS appears to be effective in improving pain, voiding frequency, urinary symptoms and quality of life in women with BPS/IC. International Painful Bladder Foundation 4 Abstract #15 AUTONOMIC RESPONSES DURING BLADDER HYDRODISTENTION REFLECT THE SEVERITY OF SYMPTOMS IN PATIENTS WITH IC/PBS. Kim S W, Jee S H, Kim J Y, Moon S Y, Lee J S, Choi J H, Seo J T, Kim J H, Hyeon C S. Previous studies have demonstrated elevated indices of sympathetic activity in patients with interstitial cystitis/painful bladder syndrome (IC/PBS). Kim and colleagues from South Korea examined autonomic responses, including changes in blood pressure (BP) and pulse rate (PR) in IC/PBS patients during bladder hydrodistention in order to evaluate the correlation between symptom severity and autonomic responses. They investigated 32 IC/PBS patients who underwent bladder hydrodistention from March 2012 to June 2013. The anaesthesia techniques were as follows: general 25 patients, spinal 6 patients, while 1 patient underwent both anaesthesia in separate distentions. 25 patients who underwent holmium laser enucleation of the prostate (HoLEP) under general anaesthesia were used as controls. They found that autonomic responses including BP and PR during hydrodistention under general anaesthesia were associated with the severity of symptoms in patients with IC/PBS, which could be used as a clinical marker of IC/PBS Abstract # 16 APPLICATION OF SODIUM ALGINATE FOR PROLONGATION OF INTRAVESICAL EFFECTS OF LIDOCAINE AND OXYBUTYNIN IN TREATMENT OF BLADDER PAIN SYNDROME. Mirkin Y, Karapetyan A, Shumoff S, Oltarzhevskaya N. Intravesical instillations of lidocaine and/or oxybutynin are widely used for reduce pain and frequency in 16 APPLICATION OF SODIUM ALGINATE FOR PROLONGATION OF INTRAVESICAL EFFECTS OF LIDOCAINE AND OXYBUTYNIN IN TREATMENT OF BLADDER PAIN SYNDROME. Mirkin Y, Karapetyan A, Shumoff S, Oltarzhevskaya N. Intravesical instillations of lidocaine and/or oxybutynin are widely used for reduce pain and frequency in treatment of BPS. The main disadvantage of this method is short duration since soon after urination all symptoms return. Prolongation of effect can be achieved by using a mixture of lidocaine and oxybutynin with a polar molecule, such as sodium alginate. This can increase adhesion of composition to the urothelium. This study estimated the efficacy of sodium alginate with lidocaine and oxybutynin in comparison with lidocaine and oxybutynin only. Mirkin et al from Russia found that lidocaine/oxybutynin with sodium alginate works longer than without. They are therefore of the opinion that this mixture can be used for intravesical administration to prolong the effect of lidocaine, oxybutynin or some other drug. Abstract # 17 A SURVEY ON CLINICAL PRACTICE OF INTERSTITIAL CYSTITIS IN JAPAN Homma Y, Yamada Y, Igawa Y, Nomiya A, Ito T, Tomoe H, Takei M, Ueda T. Homma and colleagues from Japan conducted a questionnaire survey among the members of the Society of Interstitial Cystitis of Japan (SICJ), to explore the number of IC patients, and diagnostic and therapeutic modalities commonly used in Japan. The survey was conducted in February, 2014. A questionnaire was sent to 17 A SURVEY ON CLINICAL PRACTICE OF INTERSTITIAL CYSTITIS IN JAPAN Homma Y, Yamada Y, Igawa Y, Nomiya A, Ito T, Tomoe H, Takei M, Ueda T. Homma and colleagues from Japan conducted a questionnaire survey among the members of the Society of Interstitial Cystitis of Japan (SICJ), to explore the number of IC patients, and diagnostic and therapeutic modalities commonly used in Japan. The survey was conducted in February, 2014. A questionnaire was sent to 169 members belonging to 114 medical institutions of SICJ via e-mail, addressing the number of IC patients on follow up, the number of new patients in 2013, diagnostic methods used, and the treatment employed such as medicine, intravesical therapies, and surgery. Completed questionnaires were returned from 62 institutions (20 university hospitals, 26 general hospitals and 16 clinics). The response rate was 54% (62/114). The total number of patients was 4531. Seven institutions had more than 100 patients, while 14 institutions had less than 10 patients. The average number of patients per institution was 73 (median 20). The total number of new patients in 2013 was 1214. Two institutions had more than 100 new patients a year, while 20 institutions had less than 5 patients. The average number of new patients per institution was 20 (median 7). Of the 4531 patients, 2066 (45%) patients had Hunner lesion and 1720 (38%) patients had glomerulations on hydrodistension. The percentage of Hunner type IC was highly variable among the institutions. Since this survey covered the majority of high volume IC centres in Japan, it is presumed that the results reflect the actual clinical practice of IC in Japan. While assessment methods are relatively homogenous for clinical tests and symptom evaluations, the rate of patients with Hunner lesion was highly variable among the institutions. This suggests that the criteria of Hunner lesion are far from being unified and substantial numbers of patients are not properly diagnosed and/or treated. During the presentation of this paper in Rio, Professor Homma explained that it was clear that there was apparently a considerable difference in levels of expertise between physicians with regard to their ability to International Painful Bladder Foundation 5 diagnose Hunner lesion and that clearly more education is needed. And this certainly applies worldwide and indicates that an education programme is also needed worldwide. Abstract #18 WHAT CAN URINE TELL US ABOUT INTERSTICIAL CYSTITIS/PAINFUL BLADDER SYNDROME? PRELIMIMARY DATA FROM PROTEOMIC COMPARATIVE STUDY. Moitinho R, Barretto L, Bertolla R, Bertuccez F, Camargo M, Souza G, Silva C, Almeida F.18 WHAT CAN URINE TELL US ABOUT INTERSTICIAL CYSTITIS/PAINFUL BLADDER SYNDROME? PRELIMIMARY DATA FROM PROTEOMIC COMPARATIVE STUDY. Moitinho R, Barretto L, Bertolla R, Bertuccez F, Camargo M, Souza G, Silva C, Almeida F. Interstitial cystitis/painful bladder syndrome (IC/PBS) has a large spectrum of clinical presentation and sometimes the diagnosis is not an easy task. Many patients suffer for long periods without a proper diagnosis. The main problem is the lack of reliable marker or test that could help clinicians to identify the disease. In this study from Brazil, Moitinho and colleagues performed a shotgun proteomics study to show the difference between the urinary protein profile in control subjects and patients with IC/PBS to identify possible specific proteins and networks associated with IC/PBS. According to the authors, this preliminary study demonstrated that urinary proteomic could help to identify significant difference in urinary proteins. The Brazilian study indicates a significant qualitative and quantitative difference in urinary proteins between women with and without IC/PBS. In the near future, it may be applied as a new technology to determine biomarkers and help understanding IC/PBS physiopathology. Abstract #128 ADAPTATION TO THE BRAZILIAN CULTURE OF THE QUESTIONNAIRE "RICE BLADDER SYMPTOM IMPACT SCALE – BSI-6” FOR QUALITY OF LIFE EVALUATION OF PATIENTS WITH INTERSTITIAL CYSTITIS. Fernandes M, D'Ancona C, Silva A, Lúcio A, Lopes M H. As it is important to evaluate the quality of life in patients with interstitial cystitis using a validated questionnaire and there is none available in Portuguese, it is necessary to translate and validate questionnaires128 ADAPTATION TO THE BRAZILIAN CULTURE OF THE QUESTIONNAIRE "RICE BLADDER SYMPTOM IMPACT SCALE – BSI-6” FOR QUALITY OF LIFE EVALUATION OF PATIENTS WITH INTERSTITIAL CYSTITIS. Fernandes M, D'Ancona C, Silva A, Lúcio A, Lopes M H. As it is important to evaluate the quality of life in patients with interstitial cystitis using a validated questionnaire and there is none available in Portuguese, it is necessary to translate and validate questionnaires developed, tested and used in other countries. Therefore, the aim of this study was to translate and adapt the questionnaire “Rice Bladder Symptom Impact Scale – BSI-6” to the Brazilian culture, which evaluates the quality of life of patients with IC/BPS. The methodological process of cultural adaptation aims at the acquisition of an instrument true to the original, but adapted to the culture of the country where this version will be applied. A feature of this questionnaire is that it is self-reported and due to this all of the items needed to be changed to achieve cultural equivalence, in order to make the instrument more understandable to the target audience. The changing of all items demonstrated the necessity of adapting the questionnaires developed in other countries. As the questionnaire is simple and takes little time to be applied, the authors believe that it can be useful for healthcare professionals in different practice scenarios to promote multidisciplinary action. Abstract #148 IN WHAT TYPE OF INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME IS DMSO INTRAVESICAL INSTILLATION THERAPY EFFECTIVE? Tomoe H. There are two types of IC/BPS: with or without Hunner lesions. Hydrodistension followed by transurethral148 IN WHAT TYPE OF INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME IS DMSO INTRAVESICAL INSTILLATION THERAPY EFFECTIVE? Tomoe H. There are two types of IC/BPS: with or without Hunner lesions. Hydrodistension followed by transurethral resection (TUR) and fulguration is known to be an effective means of treating lesions. While the recommendation level of intravesical instillation of dimethylsulfoxide (DMSO) as a method of intravesical instillation therapy is high, which type of IC/BPS it is effective against has been rarely reported. According to the author from Japan, hydrodistension followed by transurethral coagulation (TUC) has been performed to treat IC/BPS with Hunner lesions at their hospital since 2005. They therefore conducted a retrospective study of consecutive cases of IC/BPS in which hydrodistension had been performed in 2003–2004, when TUC was not being performed. They combined DMSO with hydrodistension in 2003 and from 2004 they performed hydrodistension alone. It was concluded that DMSO intravesical instillation therapy did not have any particular efficacy in the treatment of IC/BPS without Hunner lesions, but it was useful in both maintaining and improving the effectiveness of hydrodistension in IC/BPS with Hunner lesions. The small number of cases, the fact that the data analysis of only recurrence-free cases may not have reflected the true situation, and the fact that it was a retrospective study were limitations of this study. International Painful Bladder Foundation 6 Abstract #154 ELEVATED SERUM IMMUNOGLOBULIN E AND BLADDER EOSINOPHILS INFILTRATION SUGGEST HYPERSENSITIVITY MIGHT CONTRIBUTE TO THE PATHOGENESIS OF KETAMINE CYSTITIS. Jhang J, Jiang Y, Kuo H. The number of ketamine related cystitis (KC) cases is increasing, but the pathogenesis of KC is still unclear. Previous studies revealed bladder mast cell and eosinophil cell increased infiltration in patients with KC. Mast cell and eosinophil in tissue usually suggested hypersensitivity. This study from Taiwan investigated the possibility of hypersensitivity as pathogenetic mechanism of KC. The KC patients had higher serum IgE than the patients with IC/BPS, acute bacterial cystitis and normal controls. The bladder biopsy specimen also showed eosinophil infiltration in almost every patient. The serum IgE and submucosal eosinophil is correlated with clinical symptoms. This evidence suggests that hypersensitivity might contribute to the pathogenesis of KC. Abstract #155 DEVELOPING A CHRONIC IN-VITRO MODEL FOR BLADDER PAIN SYNDROME. Rozenberg B, Heesakkers J, Schalken J. In bladder pain syndrome (BPS), the barrier of the urothelium is compromised. This enables solutes from the155 DEVELOPING A CHRONIC IN-VITRO MODEL FOR BLADDER PAIN SYNDROME. Rozenberg B, Heesakkers J, Schalken J. In bladder pain syndrome (BPS), the barrier of the urothelium is compromised. This enables solutes from the urine to leak into the bladder wall and cause irritative symptoms. Different models are being developed to achieve a better understanding of this disease and to test therapies. Many animal models use different irritants such as acids to directly damage the lining of the bladder wall. Rozenberg and colleagues from Radboud university medical centre in the Netherlands report that in their previous studies they used protamin to damage the urothelium and create a deficient barrier. In order to set up a chronic protocol, they instil this enzyme repeatedly for longer periods of time. This could possibly interfere with glycosaminoglycan (GAG) replenishment therapies which they want to evaluate with this model. They set out to prepare a chronic model in-vitro for urothelium with a deficient barrier. In this study they aimed to evaluate the effects of lipopolysaccharide (LPS) on barrier function in-vitro and compare this to protamine. They evaluated the effect of protamine and LPS in search of the ideal chronic model in-vitro for inflamed urothelium with a deficient barrier. Protamine shows a nice decrease in TEER while the cells stay viable. The disadvantage of protamine is that it should be instilled daily because of the natural recovery of urothelium to a certain extent. Continuous instillation with this enzyme will possibly interfere with therapeutic instillations they want to test on this model. Through measuring TEER, no negative effect of LPS could be detected for barrier function. The authors are of the opinion that, for now, protamine is their best option to decrease the barrier in-vitro. These results prove the principle for animal experiments in which protamine is used to create a deficient barrier. Abstract #156 IMMUNOHISTOCHEMISTRY STUDY OF KETAMINE RELATED CYSTITIS – A CORRELATION WITH CLINICAL CHARACTERISTICS WITH UROTHELIAL DYSFUNCTION AND CHRONIC INFLAMMATION. Tsai Y, Lee C, Jhang J, Jiang Y, Kuo H. Ketamine related cystitis (KC) is a recently emergent bladder disease characterized by severe bladder irritative symptoms, bladder pain, small voided volume and upper urinary tract deterioration after long-term ketamine156 IMMUNOHISTOCHEMISTRY STUDY OF KETAMINE RELATED CYSTITIS – A CORRELATION WITH CLINICAL CHARACTERISTICS WITH UROTHELIAL DYSFUNCTION AND CHRONIC INFLAMMATION. Tsai Y, Lee C, Jhang J, Jiang Y, Kuo H. Ketamine related cystitis (KC) is a recently emergent bladder disease characterized by severe bladder irritative symptoms, bladder pain, small voided volume and upper urinary tract deterioration after long-term ketamine abuse. The changes of the bladder histology have not been well elucidated to explain the disease progression of this disease. In this study from Taiwan, Tsai and colleagues compared the urothelial dysfunction, chronic inflammation and expressions of sensory proteins in the bladder urothelium and tried to correlate these parameters with the clinical characteristics. Significantly increased inflammation, increased urothelial apoptosis and decreased junctional protein expression were noted in KC bladders. These IHC results correlated with severe bladder pain, irritative sympoms and reduced bladder capacity in severe KC bladders. The authors concluded that inflammation leading to urothelial dysfunction and upregulation of M3 receptors was evident in KC bladder and causes bladder symptoms. Abstract #157 PAINFUL BLADDER SYNDROME / INTERSTITIAL CYSTITIS AND HISTAMINE INTOLERANCE – IS THERE A LINK? Heßdörfer E.157 PAINFUL BLADDER SYNDROME / INTERSTITIAL CYSTITIS AND HISTAMINE INTOLERANCE – IS THERE A LINK? Heßdörfer E. International Painful Bladder Foundation 7 In this retrospective case collection from Germany, the role of histamine overproduction is highlighted. A total of 33 women with diagnosed interstitial cystitis were surveyed. Histamine in faecal samples was measured with a commercially available ELISA kit. Additionally, vaginal swabs were analysed for histamine producing bacteria of the Enterococcus family. In 25 of the 33 analysed women, elevated histamine levels were found in faecal samples. In 16 of the 25 women, the presence of Enterococcus spp. in vaginal swabs was also detected. In a further 4 women, only the presence of Enterococcus spp. was found. Only 4 women showed neither elevated histamine levels nor the presence of Enterococcus spp.in vaginal swabs. Elevated histamine levels and the presence of histamine producing bacteria were therefore found in the majority of women with diagnosed Interstitial Cystitis. Histamine intolerance is a poorly described disease which may be responsible for a variety of symptoms (e.g. digestive complaints and non-allergic food hypersensitivity). Histamine overproduction may mimic a mast cell burst, thus explaining the symptoms of interstitial cystitis. Abstract #158 URINARY DIVERSION FOR INTRACTABLE INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME: WHETHER THE TRANSVAGINAL URETHRECTOMY CAN PLAY A PART. Yang T, Luo D, Hu X, Shen H.158 URINARY DIVERSION FOR INTRACTABLE INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME: WHETHER THE TRANSVAGINAL URETHRECTOMY CAN PLAY A PART. Yang T, Luo D, Hu X, Shen H. This study from Sichuan University, China retrospectively evaluated the history, intraoperative, and postoperative outcomes of patients choosing major surgery as the final IC/BPS treatment. Furthermore, because ileal conduit urinary diversion with cystectomy or cystourethrectomy was selected in the majority of cases, Yang and colleagues compared the therapeutic benefits and risks of the procedures involving transvaginal urethrectomy. The medical records of the urology department outpatients experiencing frequent and painful urination for a long duration were reviewed. Patients reporting no improvement or exacerbation of symptoms were considered surgical candidates and eligible for the study. The ability of surgical candidates to endure the procedure was evaluated individually. The uncertain surgical outcome, as well as risks and benefits, were discussed with each patient. The main surgical options were urinary diversion with cystectomy or cystourethrectomy and orthotopic ileocystoplasty because of their low re-operation rate. A classical ileal conduit urinary diversion, i.e. Bricker conduit, was performed transabdominally with cystourethrectomy where the bladder was excised from the trigone to the pubourethral ligament and the urethrectomy was performed transvaginally when possible. An orthotopic ileocystoplasty was performed transabdominally with supratrigonal cystectomy where the excision did not include the trigone or the ureteral orifices. Intraoperative and postoperative medical records were retrospectively reviewed. The patient’s satisfaction was considered the main standard of successful operation. Surgical outcomes were assessed on the basis of a repeated voiding diary, visual analog scale (VSA), the Chinese edition of the MOS (medical outcomes study) item short form health survey (SF-36). The surgical outcomes were remarkable in all 14 patients. Management of the ileal conduit urinary diversion was feasible using a urine collection device. Patients reported improved social function and mental condition postoperatively due to a decreased urinary frequency. Although urethralocalized pain is associated with a worsened prognosis for substitution enterocystoplasty, few studies confirm whether the transvaginal urethrectomy can play a part. In the present data, five cystectomy and eight cystourethrectomy with ileal conduit urinary diversions were performed. Urethrectomy was performed transvaginally only as a radical operation. There was no significant association between the outcomes with urethra involvement and the transvaginal urethrectomy incidence. Hence, the urethra may not be a source of IC/BPS symptoms. Histopathologically, glandular urethritis with squamous metaplasia was the primary finding in the urethral epithelium, but typical ulceration lesions or interstitial change is absent. Furthermore, in the present study, transvaginal urethrectomy was associated with postoperative delayed healing at the transvaginal incision. The authors concluded that based on the present understanding and available therapy for interstitial cystitis/bladder pain syndrome, major surgery cannot be completely avoided. A careful and thorough evaluation weighing the individual benefits and risks is required. Overall, surgery resulted in favorable subjective and objective outcomes in the selected patients. Transvaginal urethrectomy was not recommended as an initial surgical technique.