Hunner lesion disease differs in diagnosis, treatment and outcome from bladder pain syndrome: an ESSIC working group report

Fall, Magnus; Nordling, Jørgen; Cervigni, Mauro; Oliveira, Paulo; Fariello, Jennifer Yonaitis; Hanno, Philip M.; Kåbjörn-Gustafsson, Christina; Logadóttir, Ýr; Meijlink, Jane; Mishra, Nagendra; Moldwin, Robert; Nasta, Loredana; Quaghebeur, Jörgen; Ratner, Vicki; Sairanen, Jukka; Taneja, Rajesh; Tomoe, Hikaru; Ueda, Tomohiro; Wennevik, Gjertrud Egge; Whitmore, Kristene; Wyndaele, Jean Jacques; Zaitcev, A.

doi:10.1080/21681805.2020.1730948

Cited by 54 publications

(46 citation statements)

References 47 publications

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“…As well as other studies of various populations and ethnic groups, this study demonstrated that HL–IC patients show distinct bladder‐centric clinical features in a Japanese female cohort 12,19,20 . Such evidence suggests that the presence of Hunner lesions may be an important, distinct phenotypic feature of IC/BPS 21 …”

Section: Discussionsupporting

confidence: 84%

Clinical characterization of interstitial cystitis/bladder pain syndrome in women based on the presence or absence of Hunner lesions and glomerulations

Watanabe

Akiyama

Niimi

et al. 2020

LUTS

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Objectives: To compare the clinical characteristics of three groups of female patients with interstitial cystitis/bladder pain syndrome (IC/BPS) classified according to the presence or absence of Hunner lesions (HL) and glomerulations. Methods: The clinical records of 100 female patients with IC/BPS who underwent their first bladder hydrodistension at our institution were retrospectively reviewed. They were divided into patients having (HL-IC; n = 57) or lacking (BPS; n = 43) HL. BPS patients were further classified as those with (29) and without (14) glomerulations. Among these three subtypes, demographics, comorbidities, symptom parameters including a visual analog scale for pain scores, O'Leary and Sant Symptom and Problem (OSSI/OSPI) Indices, frequency volume chart variables, and bladder capacity at hydrodistension were compared. Results: HL-IC patients were older and had higher OSSI/OSPI scores, greater daytime frequency and nocturia, reduced maximum and average voided volumes, and smaller bladder capacity at hydrodistension compared with BPS patients. Pain intensity and illness duration were comparable among the three groups. HL-IC patients had autoimmune disorders as comorbidities more often, but had psychiatric disorders and irritable bowel syndrome less often compared with BPS patients. No discernible differences in clinical characteristics of symptom severity and comorbid disorders were evident between BPS patients with and without glomerulations.

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Section: Discussionsupporting

confidence: 84%

Clinical characterization of interstitial cystitis/bladder pain syndrome in women based on the presence or absence of Hunner lesions and glomerulations

Watanabe

Akiyama

Niimi

et al. 2020

LUTS

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“…No significant linear trends were found in either group (p > .05) lesion or non-Hunner lesion BPS/IC, which may be distinct disorders. 21 Despite these shortcomings, we believe this manuscript is novel in describing the association between abnormal vagal modulation of the heart in patients with CPP and the associated abnormal electrical modulation of the stomach. We believe future work should replicate our findings in other chronic pain diagnosis to determine how vagal modulation influences (ab)normal gastric activity.…”

Section: Resultsmentioning

confidence: 96%

“…Second, the number of subjects in each group was small due to artifacts in the EEG recording. Third, due to the small numbers, we did categorize the different CPP or the BPS/IC into Hunner lesion or non‐Hunner lesion BPS/IC, which may be distinct disorders 21 . Despite these shortcomings, we believe this manuscript is novel in describing the association between abnormal vagal modulation of the heart in patients with CPP and the associated abnormal electrical modulation of the stomach.…”

Section: Discussionmentioning

confidence: 98%

Does maladaptive cardiovagal modulation extend to gastric modulation in women with chronic pelvic pain?

Williams

Muth

Thayer

et al. 2020

Neurourology and Urodynamics

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Background: Women with chronic pelvic pain (CPP) have poor cardiovagal modulation. It is unclear whether this finding reflects a broader abnormality across many systems such as gastro-vagal modulation. Aim: To determine if maladaptive cardiovagal activity in females with CPP is accompanied by maladaptive gastric myoelectric activity. Methods: A total of 36 health controls (HC) and 75 CPP underwent supine (10 min), then upright (tilted 70°head up; 30 min), and back to supine (10 min) positions. High-frequency heart rate variability (HF-HRV; 0.15-0.4 Hz) was measured as an index of cardiovagal activity. Cutaneous electrogastrography (EGG) assessed gastric myoelectric activity pre-and during-upright tilt. EGG measures from 16 HC and 31 CPP patients were available for analysis and included relative percentage of gastric activity within the normal (2-4 cpm) and tachygastria (4-10 cpm) ranges, plus ratio of normal/tachygastria. Results: HF-HRV was lower in CPP individuals at all time points (each p < .05). CPP individuals showed lesser decrease in HF-HRV from supine to upright, and poorer HF-HRV recovery from upright back to supine (F[1, 106] = 4.62, p = .034). HC showed increase in tachygastria activity (t[15] = −2.09, p = .054) while the CPP group showed no change in tachygastria activity from pre-upright to upright (t[30] = −0.62, p = .537). Conclusions: Individuals with CPP going from supine to upright demonstrate an impairment in both tachygastria and the parallel decrement in HRV. These results support the hypothesis of a generalized blunting in the physiological modulation in CPP individuals affecting both cardiovascular and gastric systems.

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“…7,8 It has been proposed that the patients with Hunner's lesion should be treated as a separate disease entity. 9 The current study aims at classifying patients on the basis of possible etiopathogensis and administering suitable treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical phenotyping linked treatment strategies in patients with bladder pain syndrome

Taneja¹,

Chugh²

2020

UNOAJ

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Introduction: This is a clinically heterogeneous entity with suboptimal results to known modalities of treatment globally. The clinical heterogeneity of this clinical syndrome is due to variable etiopathogenetic mechanisms involved in the final manifestation of symptoms. Hence it is but logical to categorize these patients into phenotypes based on suspected underlying etiology, in order to institute a treatment strategy specific to that group. Methodology: Diagnosed as BPS as per the ESSIC guidelines, 84 consecutive patients were categorized into four clinical phenotypes (CP), allergy, dysfunctional voiding, neuropathic pain and presence of Hunner's ulcer and labeled as CP 1 through 4 respectively. Patients could qualify to be categorized in more than one category. They were administered oral PPS and treatment specific to the CP. The patients from CP1 to 3 received hydroxyzine, clonazepam, and amitriptyline respectively. Patients with Hunners lesion underwent hydro distension and ablation of Hunners lesion followed by intravesical heparin and hydrocortisone solution. The patients were scored clinically and assessed as per prevailing scoring system and results were tabulated at 1,3 and 6 months. Results: Out of 86 patients, 78 were found evaluable. The CP groups from 1-4 were found to have 24,46,14,18 patients respectively. Many patients qualified for being categorized in more than one category. The response rate at 6 months was 71%, 76%, 57%, and 78% respectively for each CP while the response of overall cohort was 76%. Conclusion: Clinical phenoptyping based on features indicative of etiology helps to improve outcomes by guiding treatments focused towards addressing the specific pathological processes.

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Hunner lesion disease differs in diagnosis, treatment and outcome from bladder pain syndrome: an ESSIC working group report

Cited by 54 publications

References 47 publications

Clinical characterization of interstitial cystitis/bladder pain syndrome in women based on the presence or absence of Hunner lesions and glomerulations

Clinical characterization of interstitial cystitis/bladder pain syndrome in women based on the presence or absence of Hunner lesions and glomerulations

Does maladaptive cardiovagal modulation extend to gastric modulation in women with chronic pelvic pain?

Clinical phenotyping linked treatment strategies in patients with bladder pain syndrome

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