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underStandInG and ManaGInG
InterStItIal cyStItIS:
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: IntroductIon:
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 (urinary, psychosocial, an anaesthetic challenge test (200
organ Specific, Infection neurologic/
floor neuromuscular dysfunction which systemic and tenderness) Phenotypic
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 [6]. It appears that If patients are much more complicated patients who report pain with clInIcal phenotypInG
anesthesia) and/or patients with typical uSInG upoInt
biopsy. It is likely that future studies FaIlure oF tradItIonal
Interstitial Cystitis [4]. 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 tarGeted therapy
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 the Future
and probably the Tenderness Domains, findings (including biomarkers). We Figure: UPOINT phenotypic domains (“the
Snow Flake” Hypothesis)
Clinical Phenotyping of
Patients with Interstitial Cystitis/Painful Bladder Syndrome
Printed with Permission J. Curtis Nickel reFerenceS:
1. nickel Jc. Interstitial Cystitis: A
7. Shoskes da, nickel Jc, dolinga
r, prots d. Clinical phenotyping
14. warren Jw, horne lM, hebel
2. hanno pM. Re-imagining
Jr, Marvel rp, keay Sk, chai
tc. 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. Clinical
15. hwang p, auclair B, Beechinor
d, diment M, einarson tr.
9. karsenty G, altaweel w,
hajebrahimi S, corcos J. Efficacy
4. nickel Jc, Shoskes d, Irvine-Bird
16. van ophoven a, pokupic S,
k. Clinical Phenotyping of Women
heinecke a, hertle l. “A
10. Fall, M, oberpenning, F, peeker,
r. Treatment of Bladder Pain
5. nickel Jc, tripp da, pontari
17. nickel Jc, egerdie B , downey
Ma, et al. Phenotypical
11. Sant Gr, propert kJ, hanno
J, Singh r, Skehan a, carr l,
pM, et al: A pilot clinical trial of
Irvine-Bird k. A Real-Life Multi-
12. Mayer r, propert kJ, peters kM,
payne ck,Zhang y, Burks d et
al. A randomized controlled trial
18. peters k. Randomized multi-
6. tripp da, nickel Jc, Fitzgerald
Mp, Mayer r, Stechyson n,
hsieh a. Sexual functioning,
13. hanno p. A Re-look at the Use


Pii: s0140-6736(01)06254-7

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