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underStandInG and ManaGInG
a perSonalIZed approach
J. curtis nickel Md
Professor of Urology, Queen’s University at Kingston CanadaCIHR Canada Research Chair in Urologic Pain and InflammationKingston General Hospital, Kingston Ontario Canada K7L 2V7Phone: 613-548-2497Email: email@example.com
cystitis are angry. Physicians managing continues to improve, the two most
Beyond the Bladder
umbrella of IC. Many small treatment trials have shown promising results,
the Snow Flake
to large well designed multi-center placebo controlled clinical trials. We
have come to accept that we will likely presenting with the characteristic
will “cure” all patients diagnosed with
actually a completely unique individual well as at least one irritative voiding [3,4]. Each patient likely has a slightly
name interstitial cystitis do it justice?
Or are the recently introduced terms of find a single universal theory that
diagnosed with interstitial cystitis have
6-point UPOINT (u
sychosocial, an anaesthetic challenge test (200
rgan Specific, I
floor neuromuscular dysfunction which systemic and t
bladder will only benefit those patients
expected that most, if not all patients,
to the criteria we use clinically to make who have confirmed significant
social interactions . It appears that
If patients are much more complicated patients who report pain with
anesthesia) and/or patients with typical
biopsy. It is likely that future studies
FaIlure oF tradItIonal
Interstitial Cystitis . In developing
bladder pain, pelvic muscle pain/spasm hydroxyzine, antibiotics and various
traditional IC bladder centric therapies
efficacy. In fact the large NIH clinical
reported trials have suggested benefits sulphate), hydroxyzine for those
trials will show a differential treatment
on cystosopic and/or biopsy findings).
to treat bacteriuria in IC patients with
effect problems and would not be universally applicable to all patients.
phenotypes. The UPOINT phenotyping therapy would include medical
treated in order to achieve a successful Tenderness: Therapy for this domain
In the same trial, patients treated with
“real-life” clinical practice studies.
with Cognitive Behavioral Therapy and patients according to phenotypes
and probably the Tenderness Domains, findings (including biomarkers). We
Figure: UPOINT phenotypic domains (“the
Snow Flake” Hypothesis)
UPOINT: THE SNOW FLAKE HYPOTHESIS
Clinical Phenotyping of
Patients with Interstitial Cystitis/Painful Bladder Syndrome
Printed with Permission J. Curtis Nickel
1. nickel Jc.
Interstitial Cystitis: A
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r, prots d.
14. warren Jw, horne lM, hebel
2. hanno pM.
Jr, Marvel rp, keay Sk, chai
Pilot study of sequential oral
8. nickel Jc, Moldwin r, lee S,
3. Shoskes da, nickel Jc, rackley
davis el, henry ra, wyllie MG.
rr, pontari Ma.
15. hwang p, auclair B, Beechinor
d, diment M, einarson tr.
9. karsenty G, altaweel w,
hajebrahimi S, corcos J.
4. nickel Jc, Shoskes d, Irvine-Bird
16. van ophoven a, pokupic S,
Clinical Phenotyping of Women
heinecke a, hertle l.
10. Fall, M, oberpenning, F, peeker,
Treatment of Bladder Pain
5. nickel Jc, tripp da, pontari
17. nickel Jc, egerdie B , downey
Ma, et al.
11. Sant Gr, propert kJ, hanno
J, Singh r, Skehan a, carr l,
pM, et al
: A pilot clinical trial of
A Real-Life Multi-
12. Mayer r, propert kJ, peters kM,
payne ck,Zhang y, Burks d et
A randomized controlled trial
18. peters k.
6. tripp da, nickel Jc, Fitzgerald
Mp, Mayer r, Stechyson n,
13. hanno p.
A Re-look at the Use
Direct-to-consumer advertisements for prescription drugs: whatare Americans being sold? Steven Woloshin, Lisa M Schwartz, Jennifer Tremmel, H Gilbert Welch prescription drug appeared in Reader’s Digest in 1981billion on direct-to-consumer advertisements forprescription drugs in 1999. Our aim was to establish whatadvertisements were published, and the US Food andmessages are being commun
============================================= THE MAGNIFIER Issue #51, January, 2007 Newsletter from the Macular Degeneration Foundation, Inc. P.O. Box 531313 Henderson, NV 89053 http://www.eyesight.org ============================================= TRANSPLANTED RETINAL CELLS RESTORE VISION IN MICE Breakthrough is Major Step in Retinal repair for Humans By Ben A Shaberman: Foundation Fighting Blind