Presenting an atlas of Hunner lesions in interstitial cystitis which can be identified with office cystoscopy

Ronstrom, Carrie; Lai, H. Henry

doi:10.1002/nau.24500

Cited by 24 publications

(21 citation statements)

References 23 publications

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“…Even under cystoscopy, the diagnosis of HIC has still been contentious, with the prevalence of HIC reported to range from 5 to 57% through different regions of the world [16]. With the aid of a Hunner's lesion atlas, urologists could improve their consensus regarding the diagnosing of HIC through office cystoscopy [17]. However, intra-observer reliability in the identification of characteristic Hunner's lesion has still been somewhat controversial.…”

Section: Discussionmentioning

confidence: 99%

Possible Association between Bladder Wall Morphological Changes on Computed Tomography and Bladder-Centered Interstitial Cystitis/Bladder Pain Syndrome

Jhang

Hsu

et al. 2021

Biomedicines

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This study aimed to evaluate the clinical significance of urinary bladder wall thickening on computed tomography (CT) among patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Patients with IC/BPS were prospectively enrolled and classified into three groups according to bladder CT finding: smooth bladder wall, focal bladder thickening, and diffuse bladder thickening. Among the 100 patients with IC/BPS, 49, 36, and 15 had smooth bladder wall, focal bladder thickening, and diffuse bladder thickening on CT, respectively. Patients with Hunner’s lesion showed a higher proportion of diffuse and focal bladder thickening compared to those without the same (p < 0.001). Patients with diffuse bladder thickening displayed smaller first sensation of filling, cystometric bladder capacity, and voided volume compared to the rest (all p < 0.001). Patients with focal and diffuse thickening had a higher proportion of inflammatory cell infiltration, uroepithelial cell denudation, and granulation tissue compared to those with smooth bladder wall (p = 0.045, 0.002, and 0.005, respectively). Bladder wall thickening on CT was correlated with clinical phenotypes of IC/BPS, including histopathological findings. Focal or diffuse bladder wall thickening on CT might indicate the presence of chronic bladder wall inflammation and fibrosis and could be used to differentiate bladder-centered IC/BPS.

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Section: Discussionmentioning

confidence: 99%

Possible Association between Bladder Wall Morphological Changes on Computed Tomography and Bladder-Centered Interstitial Cystitis/Bladder Pain Syndrome

Jhang

Hsu

et al. 2021

Biomedicines

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“…This limitation needs to be addressed in future clinical guidelines because without cystoscopy one cannot really distinguish HL from non‐HL. A recent paper has provided a visual atlas to facilitate the proper diagnosis of Hunner lesion on office cystoscopy 34 …”

Section: Discussionmentioning

confidence: 99%

“…A recent paper has provided a visual atlas to facilitate the proper diagnosis of Hunner lesion on office cystoscopy. 34 The identification of HL serves as an example where the use of clinical phenotyping may help to inform individualized treatments to patients with UCPPS. Using a "one size fits all" approach to manage IC/BPS or CP/CPPS without regards for differentiating clinical characteristics may lead to treatment failures.…”

Section: Quality Of Life Nsmentioning

confidence: 99%

Comparison of deep phenotyping features of UCPPS with and without Hunner lesion: A MAPP‐II Research Network Study

Lai

Newcomb

Harte

et al. 2021

Neurourology and Urodynamics

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Objective: To use the phenotyping data from the MAPP-II Symptom Patterns Study (SPS) to compare the systemic features between urologic chronic pelvic pain syndrome (UCPPS) with Hunner lesion (HL) versus those without HL. Methods: We performed chart review on 385 women and 193 men with UCPPS who enrolled in the MAPP-II SPS. 223 had cystoscopy and documentation of HL status. Among them, 12.5% had HL and 87.5% did not. Results: UCPPS participants with HL were older, had increased nocturia, higher Interstitial Cystitis Symptom and Problem Indexes, and were more likely to report "painful urgency" compared with those without HL. On the other hand, UCPPS without HL reported more intense nonurologic pain, greater distribution of pain outside the pelvis, greater numbers of comorbid chronic overlapping pain conditions, higher fibromyalgia-like symptoms, and greater pain centralization, and were more likely to have migraine headache than those with HL. UCPPS without HL also had higher anxiety, perceived stress, and pain catastrophizing than those with HL. There were no differences in sex distribution, UCPPS symptom duration, intensity of urologic pain, distribution of genital pain, pelvic floor tenderness on pelvic examination, quality of life, depression, pain characteristics (nociceptive pain vs. neuropathic pain), mechanical hypersensitivity in the suprapubic area during quantitative sensory testing, and 3-year longitudinal pain outcome and urinary outcome between the two groups. Conclusions: UCPPS with HL displayed more bladder-centric symptom profiles, while UCPPS without HL displayed symptoms suggesting a more Abbreviations: COPC, chronic overlapping pain condition(s); HL, Hunner lesion; MAPP, multidisciplinary approach to the study of chronic pelvic pain; QST, quantitative sensory testing; SPS, symptom pattern study; UCPPS, urologic chronic pelvic pain syndrome.

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“…Thus, it is necessary to standardize the methodology of the cystoscopic assessment of Hunner lesions. A recent article by Ronstrom and Lai presented an informative atlas showing cystoscopic photos of typical Hunner lesions in IC/BPS patients [37]. However, there is still a need to define atypical or small Hunner lesions, which will be missed under conventional cystoscopy with white light [35].…”

Section: The Specificity Of Cystoscopic Findingsmentioning

confidence: 99%

Current Understanding and Future Perspectives of Interstitial Cystitis/Bladder Pain Syndrome

Ueda¹,

Hanno

Saito³

et al. 2021

Int Neurourol J

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Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease characterized by suprapubic pain and lower urinary tract symptoms. Perhaps because of the heterogeneous nature of this disease and its multifactorial etiology, clinical trials in allinclusive populations of IC/BPS patients without phenotyping in the last decade have mainly failed to discover new therapeutic modalities of IC/BPS. Thus, phenotyping IC/BPS, aimed at identifying bladder-centric and/or bladder-beyond pathologies, including cystoscopic observation of Hunner or non-Hunner lesions of the bladder mucosa, is particularly important for the future of IC/BPS management. Based on recent discussions at international conferences, including the International Consultation on IC, Japan, it has been proposed that Hunner-lesion IC should be separated from other non-Hunner IC/BPS because of its distinct inflammatory profiles and epithelial denudation compared with non-Hunner IC/BPS. However, there are still no standard criteria for the diagnosis of Hunner lesions other than typical lesions, while conventional cystoscopic observations may miss atypical or small Hunner lesions. Furthermore, diagnosis of the bladder-centric phenotype of IC/BPS requires confirmation that identified mucosal lesions are truly a cause of bladder pain in IC/BPS patients. This review article discusses the current status of IC/BPS pathophysiology and diagnosis, as well as future directions of the proper diagnosis of bladder-centric IC/BPS, in which pathophysiological mechanisms other than those in inflammatory pathways, such as angiogenic and immunogenic abnormalities, could also be involved in both Hunner-lesion IC and non-Hunner IC/BPS. It is hoped that this new paradigm in the pathophysiological evaluation and diagnosis of IC/BPS could lead to pathology-based phenotyping and new treatments for this heterogeneous disease.

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Presenting an atlas of Hunner lesions in interstitial cystitis which can be identified with office cystoscopy

Cited by 24 publications

References 23 publications

Possible Association between Bladder Wall Morphological Changes on Computed Tomography and Bladder-Centered Interstitial Cystitis/Bladder Pain Syndrome

Possible Association between Bladder Wall Morphological Changes on Computed Tomography and Bladder-Centered Interstitial Cystitis/Bladder Pain Syndrome

Comparison of deep phenotyping features of UCPPS with and without Hunner lesion: A MAPP‐II Research Network Study

Current Understanding and Future Perspectives of Interstitial Cystitis/Bladder Pain Syndrome

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