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BackTable / OBGYN / Podcast / Episode #38

Painful Bladder Syndrome

with Dr. Jocelyn Fitzgerald

In this episode, hosts Dr. Mark Hoffman and Dr. Amy Park invite Dr. Jocelyn Fitzgerald to discuss the relationships among chronic inflammatory pelvic diseases, focusing on painful bladder syndrome / interstitial cystitis (IC) and endometriosis. Dr. Fitzgerald is a urogynecologist at Magee Women’s Hospital in Pittsburgh, PA.

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Painful Bladder Syndrome with Dr. Jocelyn Fitzgerald on the BackTable OBGYN Podcast)
Ep 38 Painful Bladder Syndrome with Dr. Jocelyn Fitzgerald
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BackTable, LLC (Producer). (2023, November 9). Ep. 38 – Painful Bladder Syndrome [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Jocelyn Fitzgerald discusses Painful Bladder Syndrome on the BackTable 38 Podcast

Dr. Jocelyn Fitzgerald

Dr. Jocelyn Fitzgerald is a urogynecologist and pelvic reconstructive surgeon and an assistant professor at University of Pittsburgh Medical Center in Pennsylvania.

Dr. Amy Park discusses Painful Bladder Syndrome on the BackTable 38 Podcast

Dr. Amy Park

Dr. Amy Park is the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic, and a co-host of the BackTable OBGYN Podcast.

Dr. Mark Hoffman discusses Painful Bladder Syndrome on the BackTable 38 Podcast

Dr. Mark Hoffman

Dr. Mark Hoffman is a minimally invasive gynecologic surgeon at the University of Kentucky.

Synopsis

The episode begins with Dr. Fitzgerald describing her pathway into urogynecology, including training with MIGS physicians. This allowed her to make the connection between many young, reproductive-aged women with painful urination who also have endometriosis. She then goes into how to define IC, which can be difficult. Officially, it is bothersome urinary symptoms lasting more than 6 weeks without other identifiable causes. It is almost always a diagnosis of exclusion after negative urine cultures and other tests. Cystoscopy is no longer needed for diagnosis as it is often normal. However, the best understood phenotype of IC is bladder-centric IC, and these have Hunter lesions seen with cystoscopy. This type responds very well to fulguration, Kenalog, or steroid injections with 85% of patients experiencing improvement.

Dr. Fitzgerald further discusses treatments for IC. Behavior modification is essential, and she advises that patients avoid alcohol, coffee, tea, soda, spicy things, acidic things, and any other dietary triggers. She is also doing trials of giving patients an “IC bundle” which includes neurogenic medications like amitriptyline or gabapentin, vaginal estrogen, scheduled Pyridium, Hiprex, and aloe vera tablets. For some patients, she offers bladder instillations (comprised of heparin, lidocaine, bicarbonate, kenalog, +/- gentamicin), pelvic floor injections of bupivacaine and kenalog, and pelvic floor PT.

Next, Dr. Fitzgerald discusses the basic science research she has done that connects pain pathways throughout the pelvis. Chronic pelvic inflammatory disorders cross-talk through central sensitization. The lumbosacral plexus nerve roots receive pain signals from the bladder, colon, and other pelvic organs, explaining the relationship between IBS, endometriosis, and IC. The pathways are well understood, but we don’t yet know how to reverse central sensitization.

Finally, Dr. Fitzgerald ends by describing the multidisciplinary clinic for endometriosis at Pittsburgh: MIGS, urogynecologists, pelvic floor PT, and behavioral health teams all work together to care for these complex patients holistically. She stresses the importance of teamwork and great administrators who have made this happen. She finishes by discussing how researching more about mast cells, especially through COVID patients, can help us learn more about these chronic inflammatory disorders of the pelvis.

Resources

Fitzgerald JJ, Ustinova E, Koronowski KB, de Groat WC, Pezzone MA. Evidence for the role of mast cells in colon-bladder cross organ sensitization. Auton Neurosci. 2013 Jan;173(1-2):6-13. doi: 10.1016/j.autneu.2012.09.002. Epub 2012 Nov 24. PMID: 23182915; PMCID: PMC3715122.

AUA Guidelines for Diagnosis and Treatment of IC:
https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

Transcript Preview

[Dr. Jocelyn Fitzgerald]
I really do think I am trying very hard to create a paradigm shift. I use social media a lot for how people think about IC, painful bladder syndrome. I really truly believe in my heart of hearts that, especially in young reproductive-aged women and probably a little bit postmenopausal women, that's a little bit of a discussion for another day. When you have that "recurrent UTI" patient with negative cultures, IC symptoms, all this other pelvic pain. They're usually in their 20s, usually have seen a bajillion doctors by the time they get to you. I'd say 85% of those patients have endometriosis. That's really like the root of their bladder pain is neurogenic inflammation that is sensitizing their bladder afferents. That's what all the basic science shows is often the pathophysiology of that.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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