New Aspects in the Differential Diagnosis and Therapy of Bladder Pain Syndrome/Interstitial Cystitis

Abstract

Diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC) is presently based on mainly clinical symptoms. BPS/IC can be considered as a worst-case scenario of bladder overactivity of unknown origin, including bladder pain. Usually, patients are partially or completely resistant to anticholinergic therapy, and therapeutical options are especially restricted in case of BPS/IC. Therefore, early detection of patients prone to develop BPS/IC symptoms is essential for successful therapy. We propose extended diagnostics including molecular markers. Differential diagnosis should be based on three diagnostical “columns”: (i) clinical diagnostics, (ii) histopathology, and (iii) molecular diagnostics. Analysis of molecular alterations of receptor expression in detrusor smooth muscle cells and urothelial integrity is necessary to develop patient-tailored therapeutical concepts. Although more research is needed to elucidate the pathomechanisms involved, extended BPS/IC diagnostics could already be integrated into routine patient care, allowing evidence-based pharmacotherapy of patients with idiopathic bladder overactivity and BPS/IC.

Challenges and current evidence on the management of bladder pain syndrome

“…In addition, in patients with voiding symptoms, urodynamic assessment may confirm the diagnosis of voiding dysfunction, which may have a synergistic effect in exacerbating symptoms of BPS and act as a confusable disease. The use of urodynamics gives information about concomitant lower urinary tract symptoms and may exclude confusable diseases, such as OAB . On urodynamics, many BPS patients have bladder oversensitivity and overactivity, reduced bladder capacities, and pain with bladder filling at low volumes .…”

“…However, there are patients who report urgency, something that does not always correlate with urodynamic findings. Therefore, a significant part of the patients diagnosed with OAB, may suffer from an early stage of BPS . Nordling et al suggest that in female candidates for BPS diagnosis, flowmetry, post void residual urine volume and pressure‐flow study are optional.…”

“…Others suggest that it is essential to include histopathological and molecular biological examination of bladder biopsies into the diagnosis. Since all cellular components of the bladder seem to be involved in the pathophysiology of BPS, only histological examination of deep biopsy, spanning the whole bladder wall, ensures proper diagnosis . In the future, biopsy data will identify BPS subgroups with different therapeutic potentials.…”

“…Some authors suggest that cystoscopy must be routinely used for the diagnosis of BPS, otherwise the majority of patients will be missed, but the professional associations state that there is no need for use of invasive studies to confirm the diagnosis of BPS . There are no specific cystoscopic diagnostic findings for BPS, and in many cases cystoscopy can be completely normal.…”

“…It affects the bladder and can cause urgency, frequency, nocturia and chronic pain, in the absence of any identifiable cause. Exclusion conditions include bacterial infection, carcinoma or obstruction, urogenital prolapse, endometriosis, overactive bladder (OAB), urethral diverticulum, prostate/cervical cancer, chronic inflammation and various investigations are often required for diagnosis. It has a significant impact on quality of life and can affect mental health and sexual function.…”