Bladder condition mimics gynecologic disorders.(Gynecology)

SCOTTSDALE, ARIZ. -- Many women diagnosed with gynecologic disorders actually have a bladder condition that causes frequency, urgency, and lower pelvic pain, Dr. C. Lowell Parsons told physicians at the annual meeting of the Central Association of Obstetricians and Gynecologists.

Dr. Parsons, a professor of urology and surgery at the University of California, San Diego, said the underlying etiology is a condition he calls lower urinary dysfunctional epithelium, or LUDE. The term refers to a compromised mucous barrier that fails to protect the bladder wall from irritants such as potassium in urine.

Recurrent urinary tract infections, dyspareunia, endometriosis, vaginitis, and vulvodynia as well as interstitial cystitis are among the conditions that present with symptoms of LUDE, according to Dr. Parsons.

Dr. Parsons treats new interstitial cystitis patients with a solution containing heparin or pentosan polysulfate sodium (Elmiron) and lidocaine. "If it takes away the symptoms, you know what the cause is," he said.

His work contributed to the development of Elmiron, which the U.S. Food and Drug Administration approved in 1996 for relief of bladder pain or discomfort associated with interstitial cystitis. He disclosed that he has received research support and serves as a lecturer for Ortho-McNeil Inc.

He recommended the following intravesical therapeutic solution for patients with LUDE symptoms: 40,000 units of heparin or 100 mg of pentosan polysulfate sodium, 8 mL of 2% lidocaine, and 4 mL of sodium bicarbonate (8.4%). The bladder should be empty when the solution is used, he said.

In a trial reported earlier this year, 33 (94%) of 35 interstitial cystitis patients treated with a variation of the solution containing 2% lidocaine had 50% or greater symptom improvement. In another group of 47 patients given a variation of the solution with 1% lidocaine, 35 (74%) experienced ...