Broaden Horizons: The Advancement of Interstitial Cystitis/Bladder Pain Syndrome

Abstract

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating disease that induces mental stress, lower urinary symptoms, and pelvic pain, therefore resulting in a decline in quality of life. The present diagnoses and treatments still lead to unsatisfactory outcomes, and novel diagnostic and therapeutic modalities are needed. Although our understanding of the etiology and pathophysiology of IC/BPS is growing, the altered permeability of the impaired urothelium, the sensitized nerves on the bladder wall, and the chronic or intermittent sensory pain with inaccurate location, as well as pathologic angiogenesis, fibrosis, and Hunner lesions, all act as barriers to better diagnoses and treatments. This study aimed to summarize the comprehensive information on IC/BPS research, thereby promoting the progress of IC/BPS in the aspects of diagnosis, treatment, and prognosis. According to diverse international guidelines, the etiology of IC/BPS is associated with multiple factors, while the presence of Hunner lesions could largely distinguish the pathology, diagnosis, and treatment of non-Hunner lesions in IC/BPS patients. On the basis of the diagnosis of exclusion, the diverse present diagnostic and therapeutic procedures are undergoing a transition from a single approach to multimodal strategies targeting different potential phenotypes recommended by different guidelines. Investigations into the mechanisms involved in urinary symptoms, pain sensation, and bladder fibrosis indicate the pathophysiology of IC/BPS for further potential strategies, both in diagnosis and treatment. An overview of IC/BPS in terms of epidemiology, etiology, pathology, diagnosis, treatment, and fundamental research is provided with the latest evidence. On the basis of shared decision-making, a multimodal strategy of diagnosis and treatment targeting potential phenotypes for individual patients with IC/BPS would be of great benefit for the entire process of management. The complexity and emerging evidence on IC/BPS elicit more relevant studies and research and could optimize the management of IC/BPS patients.

MiR‐9‐enriched mesenchymal stem cells derived exosomes prevent cystitis‐induced bladder pain via suppressing TLR4/NLRP3 pathway in interstitial cystitis mice

“…IC/BPS is one of the most intractable diseases in urology today. 34 As a prominent symptom of IC/BPS, bladder pain seriously affects patients' ability to perform daily work and quality of life. 35 Due to the etiology and pathogenesis of IC/BPS remains elusive, traditional treatment methods do not guarantee a satisfactory therapeutic effect and even produce detrimental side effects.…”

“…IC/BPS is one of the most intractable diseases in urology today 34 . As a prominent symptom of IC/BPS, bladder pain seriously affects patients' ability to perform daily work and quality of life 35 .…”

Molecular Profiling of Inflammatory Processes in a Mouse Model of IC/BPS: From the Complete Transcriptome to Major Sex-Related Histological Features of the Urinary Bladder

“…To date, the pathophysiology of IC/BPS remains largely unexplained, as it is a heterogeneous and complex disorder with unspecific clinical symptoms and pathologic findings that often overlap with other bladder-related pathologies [ 3 ]. Transcriptome profiling has become invaluable for research in IC/BPS as it is helping to elucidate the molecular mechanisms involved in disease development and progression.…”

“…In contrast, the majority of patients show no histopathologic changes in the bladder (non-Hunner type of IC/BPS). Setting the right diagnosis of both types of IC/BPS remains challenging, and as a consequence, the disease is gravely underdiagnosed [ 1 , 3 ]. In addition, current therapeutic approaches for IC/BPS mostly aim to relieve the pain through behavioral alterations and medication, but rarely provide a complete resolution of symptoms [ 1 ].…”

“…The prevalence of IC/BPS has been reported to vary based on race, geographic region, and disease awareness [ 3 , 15 ]. However, the women-to-men ratio in incidence of the disease is considered to be approximately 5:1 [ 16 ].…”