New Orleans, Louisiana Jul 22, 2024 (Issuewire.com) - Interstitial Cystitis (IC), also known as Bladder Pain Syndrome (BPS), is a chronic condition characterized by bladder pain, urinary urgency, and frequency. According to Dr. Nicholas Franco, a retired urologist with extensive experience in treating IC across North America, various treatment options are available, ranging from conservative management to advanced surgical interventions.
Conservative Management of IC/BPS
Dr. Nicholas Franco emphasizes that conservative management forms the cornerstone of initial treatment for IC/BPS. Patients are encouraged to make lifestyle modifications, such as dietary changes, to avoid potential irritants like caffeine, alcohol, and spicy foods. Additionally, Dr. Nicholas Franco says stress management techniques and bladder training exercises are recommended to reduce symptom severity and improve quality of life without medical intervention.
Non-Pharmacological Treatments
In addition to conservative management, Dr. Nicholas Franco explains the importance of non-pharmacological treatments. These encompass a variety of approaches, including physical therapy to address pelvic floor dysfunction, acupuncture, and bladder instillations using agents such as heparin and lidocaine. These therapies, he says, can provide significant symptom relief for many patients, particularly those who prefer to avoid systemic medications.
Oral Medications
For those requiring medication, several oral options have proven effective in managing IC symptoms. Dr. Nicholas Franco highlights Pentosan Polysulfate Sodium (Elmiron) as the only FDA-approved oral medication specifically for IC, which helps to restore the bladder's protective lining. Tricyclic antidepressants, such as amitriptyline, can reduce pain and urinary frequency by modulating nerve signals. Dr. Nicholas Franco says that histamine and leukotriene receptor inhibitors, like hydroxyzine, target the immune response, potentially reducing bladder inflammation. In severe cases, immunosuppressants, including cyclosporine, may be considered. Dr. Nicholas Franco adds that an emerging treatment, Rosiptor (AQX-1125), targets the SHIP1 pathway to reduce inflammation and improve symptoms.
Intravesical Medications
Dr. Nicholas Franco also discusses the role of intravesical therapy, which involves directly instilling medication into the bladder. Dimethyl Sulfoxide (DMSO) is the only FDA-approved intravesical treatment for IC, possessing anti-inflammatory and analgesic properties. He adds that other intravesical agents, such as lidocaine, heparin, and hyaluronic acid, are used to soothe the bladder lining and reduce symptoms.
Intravesical Physical Treatments
Dr. Nicholas Franco says that intravesical physical treatments, like hydrodistention, are another effective option in treating IC. Performed under anesthesia, and hydrodistention, Dr. Nicholas Franco states, this option involves:
Stretching the bladder by filling it with fluid.
Providing temporary symptom relief.
Diagnosing the severity of IC.
Neuromodulation
Neuromodulation techniques, such as sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS), Dr. Nicholas Franco notes, target the nerves controlling bladder function. These minimally invasive procedures, he says, can significantly alleviate symptoms for many patients.
Botulinum Toxin A
According to Dr. Nicholas Franco, Botulinum toxin A (Botox) injections into the bladder muscle can reduce pain and urinary urgency by relaxing the bladder. This treatment is typically reserved for patients who do not respond to other therapies.
Surgical Options
Dr. Nicholas Franco says that surgical options are considered a last resort for severe, refractory cases. Cystoscopic laser surgery, he says, targets and destroys abnormal bladder tissue. Augmentation cystoplasty, Dr. Nicholas Franco states, involves enlarging the bladder with segments of the intestine to increase capacity and reduce symptoms. In the most severe cases, Dr. Nicholas Franco adds, urinary diversion creates a new way for urine to exit the body, bypassing the bladder entirely.
About Dr. Nicholas Franco
Dr. Franco's extensive career, which spanned Montreal, New Orleans, and Southwest Florida, has provided him with a deep understanding of IC and its treatments. His dual citizenship in Canada and the USA, combined with his academic journey at McGill University, the University of Montreal, and specialized fellowships, has contributed to his expertise. With significant academic roles, including Associate Clinical Professor of Surgery at Tulane University and contributions to fellowship programs at LSU, Dr. Nicholas Franco's insights into IC treatments are invaluable.
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