Features of Various Bladder Lesions and Their Impact on Clinical Symptoms and Recurrence in Interstitial Cystitis

Abstract

Purpose: We aimed to investigate the impact of various bladder lesions on the clinical symptoms and recurrence of interstitial cystitis (IC). Materials and Methods: Patients with IC who underwent transurethral resection and cauterization for Hunner lesions (HLs) were enrolled. Features of HLsdnoninflamed, inflamed, and gradually inflameddand associated cystoscopic findings, including waterfall bleeding (none, focal or extensive), submucosal hemorrhage, and mucosal streak, were analyzed to investigate their association with preoperative symptoms and recurrence. Results: We included 272 procedures from 141 patients (male:female ratio 37:104) with a meanAESD age of 61.4AE10.5 years. Recurrence was observed in 160 procedures after a mean of 15.6 months (range 0.7e91.7); repeat transurethral resection and cauterization was performed in 131 cases. The number of HLs observed at each procedure was variable, and sufficient bladder filling revealed hidden lesions in 10.7% of cases. Waterfall bleeding was frequently accompanied with inflamed/gradually inflamed HLs. Inflammatory HLs were associated with smaller functional bladder capacity and preoperative urgency (p[0.007). Extensive waterfall bleeding was associated with smaller functional bladder capacity (p[0.006). On multivariate analysis, initially inflamed HLs (HR: 1.675, 95% CI: 1.022e2.746, p[0.041) and gradual inflammatory changes in HLs (HR: 1.893, 95% CI: 1.050e3.410, p[0.034) were found to be risk factors for recurrence. Conclusions: Sufficient bladder filling revealed hidden HLs. The features of HLs were not associated with subjective symptoms; inflamed changes were a predictive factor for IC recurrence, and associated with frequent urgency episodes and smaller bladder capacity.

Supervised machine learning algorithm identified KRT20, BATF and TP63 as biologically relevant biomarkers for bladder biopsy specimens from interstitial cystitis/bladder pain syndrome patients

“…Although the criteria of the diagnosis is the confirmation of Hunner’s lesions by cystoscopy, the conditions under which cystoscopy is carried out must be carefully considered. Cystoscopy in the outpatient setting, where adequate bladder dilatation can be difficult, misses 10.9% of Hunner’s lesions 5 . Thus, the current diagnosis relies on subjective evaluation by cystoscopy, which might not be perfect, and we hoped to add an objective element to the diagnosis by establishing novel biomarkers in the present study.…”

“…Cystoscopy in the outpatient setting, where adequate bladder dilatation can be difficult, misses 10.9% of Hunner's lesions. 5 Thus, the current diagnosis relies on subjective evaluation by cystoscopy, which might not be perfect, and we hoped to add an objective element to the diagnosis by establishing novel biomarkers in the present study.…”

Dehydrated Human Amnion-Chorion Membrane Extracts Can Ameliorate Interstitial Cystitis in Rats by Down-Regulating Inflammatory Cytokines and Protein Coding Genes: A Preclinical Study

“…Nonetheless, there are no direct links between hematuria and life-threatening or symptomatic IC [22,23]. The former might be associated with smaller functional capacity of UB and urgency [24]. Since HLs were considered a sign of frequent recurrence [24], treating hematuria could be meaningful in preventing IC deterioration to some extent.…”

“…The former might be associated with smaller functional capacity of UB and urgency [24]. Since HLs were considered a sign of frequent recurrence [24], treating hematuria could be meaningful in preventing IC deterioration to some extent. A,B) The expressions of caspase-3 and Bax were higher in the IC group than in the treatment group, while the anti-apoptotic Bcl-2 was higher in the treatment group than in the IC group.…”

Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. Letter.

“…However, no placebo controlled clinical trials have demonstrated any benefit since the questionable pivotal trials 30+ years ago that showed no objective symptom changes, and only a 30% improvement on an unbalanced PORIS (Patient's Overall Rating of Improvement of Symptoms) scale that would no longer be considered valid for drug approval studies. 3,4 Subsequent U.S. Food and Drug Administration mandated phase 4 trials showed no dose response with triple the approved dose, 5 and no response over placebo. 6 With the growing literature on the increased risk of maculopathy associated with chronic administration and U.S. Food and Drug Administration black box warning regarding its use, it would seem this drug’s risk/benefit ratio should preclude its guideline recommendation in 2022.…”