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

Ryoichi Saito|Naoki Yoshimura|Tomohiro Ueda|Philip M. Hanno|Jane M. Meijlink
대한배뇨장애요실금학회 (Korean Continence Society)|2021.06|International Neurourology Journal|제25권 제2호|pp. 99-110|DOI 10.5213/inj.2142084.042

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키워드

Interstitial cystitisCystoscopyBladder pain syndromeAngiogenesisHunner lesionNarrow-band imaging

초록

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.

Abstract

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.

참고문헌 (41)

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관련 논문AI추천

Update on the Pathology and Diagnosis of Interstitial Cystitis/ Bladder Pain Syndrome: A Review김현정대한배뇨장애요실금학회 · International Neurourology Journal2016 · 제20권 제1호Pathomechanism of Interstitial Cystitis/Bladder Pain Syndrome and Mapping the Heterogeneity of DiseaseHann-Chorng Kuo, Jia-Fong Jhang대한배뇨장애요실금학회 · International Neurourology Journal2016 · 제20권 제1호간질성 방광염에서 염증반응으로 인한 요로점막의 변화배재현, 최훈상대한요로생식기감염학회 · Urogenital Tract Infection2013 · 제8권 제2호Differences in Urodynamic Parameters According to the Presence of a Hunner Lesion in Women With Interstitial Cystitis/Bladder Pain Syndrome김종욱, 문두건, 박태용, 박홍석, 안순태, 오미미, 이정구, 정형국대한배뇨장애요실금학회 · International Neurourology Journal2018 · 제22권 제1호Potential Mechanisms Underlying the Increased Excitability of the Bladder Afferent Pathways in Interstitial Cystitis/Bladder Pain Syndrome김두상대한요로생식기감염학회 · Urogenital Tract Infection2018 · 제13권 제2호Is Urethral Pain Syndrome Really Part of Bladder Pain Syndrome?조성태대한요로생식기감염학회 · Urogenital Tract Infection2017 · 제12권 제1호

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