Interstitial Cystitis/Bladder Pain Syndrome

Abstract

Interstitial cystitis/bladder pain syndrome is an uncommon but potentially devastating pelvic pain disorder affecting both women and men. This condition is often confusable and comorbid with other pelvic pain disorders. Although our understanding of the underlying pathophysiology is growing, the exact longitudinal course by which peripheral and central aberrations involving the bladder mucosa, peripheral inflammation, and central dysregulation of bladder sensitivity create painful bladder symptoms remains an area in need of further study. Only a limited number of drugs have been approved for treatment by the Food and Drug Administration, and overall durable efficacy of the many treatments reviewed in recent American Urological Association guidelines remains suboptimal, making awareness, early diagnosis, and use of effective treatments early in the disease course, where neural changes may still be reversible, imperative.

An update on treatment options for interstitial cystitis

“…The term BPS alone is considered the most appropriate, because the related clinical diagnostic criteria are more inclusive than those based only on cystoscopy and histological findings, which does not recognize up to the 60% of patients. On that basis, some guidelines does not further require cystoscopy for the diagnosis [ 1 , 3 - 5 ]. The BPS is defined by clinical symptoms and is based on the hypothesis that women affected by this condition are a homogenous group having a disease with the same etiopathogenesis, with subgroups distinguished by positive signs [ 5 ].…”

“…On that basis, some guidelines does not further require cystoscopy for the diagnosis [ 1 , 3 - 5 ]. The BPS is defined by clinical symptoms and is based on the hypothesis that women affected by this condition are a homogenous group having a disease with the same etiopathogenesis, with subgroups distinguished by positive signs [ 5 ]. Nevertheless, although in IC/BPS the terms BPS and IC are reported together due to formal/historical reasons, they are not actually the same concept.…”

“…IC diagnosis requires cystoscopy with bladder hydrodistension and/or some peculiar morphological findings in bladder biopsies. The findings of cystoscopy can be glomerulations or Hunner lesions; meanwhile, histologic evaluation of mucosal biopsy can show inflammatory infiltrates, granulation tissue, detrusor mastocytosis, and/or interfascicular fibrosis [ 1 , 4 , 5 ]. The diagnosis of BPS is actually based on clinical symptoms after the exclusion of other urological and gynecological conditions having similar presentation and/or on the cystoscopic/histologic findings [ 4 ].…”

“…The improved understanding of the BPS pathophysiology has raised the numbers of diagnosis, although the variations over time of BPS diagnostic criteria has meant that epidemiological studies reported different statistics on prevalence [ 5 ]. Based on the less and the most inclusive definitions, the BPS prevalence in women was reported ranging between 0.83% and 2.71% [ 12 ].…”

“…Although the growing body of evidence about the IC/BPS clinical presentation and pathophysiology, the real etiopathogenesis is not completely understood as well as the role of the different cystoscopic/histologic presentation. These factors limit the available evidence-based treatment options, that are of paramount importance to maximize treatment outcomes since the early stages of the disease [ 5 , 14 ]. Noteworthy, the early diagnosis has a key role in the syndrome [ 15 ], that is a pain syndrome and can determine a pelvic cross-organ sensitization worsening symptoms and hardening management and resolution.…”