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

Objectives: There is confusion about the terms of bladder pain syndrome (BPS) and Interstitial Cystitis (IC). The European Society for the Study of IC (ESSIC) classified these according to objective findings [9]. One phenotype, Hunner lesion disease (HLD or ESSIC 3C) differs markedly from other presentations. Therefore, the question was raised as to whether this is a separate condition or BPS subtype.Methods: An evaluation was made to explore if HLD differs from other BPS presentations regarding symptomatology, physical examination findings, laboratory tests, endoscopy, histopathology, natural history, epidemiology, prognosis and treatment outcomes.Results: Cystoscopy is the method of choice to identify Hunner lesions, histopathology the method to confirm it. You cannot distinguish between main forms of BPS by means of symptoms, physical examination or laboratory tests. Epidemiologic data are incomplete. HLD seems relatively uncommon, although more frequent in older patients than non-HLD. No indication has been presented of BPS and HLD as a continuum of conditions, one developing into the other.Conclusions: A paradigm shift in the understanding of BPS/IC is urgent. A highly topical issue is to separate HLD and BPS: treatment results and prognoses differ substantially. Since historically, IC was tantamount to Hunner lesions and interstitial inflammation in the bladder wall, still, a valid definition, the term IC should preferably be reserved for HLD patients. BPS is a symptom syndrome without specific objective findings and should be used for other patients fulfilling the ESSIC definitions.

Scandinavian journal of urology. 2020 Feb 28 [Epub ahead of print]

Magnus Fall, Jørgen Nordling, Mauro Cervigni, Paulo Dinis Oliveira, Jennifer Fariello, Philip Hanno, Christina Kåbjörn-Gustafsson, Yr Logadottir, Jane Meijlink, Nagendra Mishra, Robert Moldwin, Loredana Nasta, Jorgen Quaghebeur, Vicki Ratner, Jukka Sairanen, Rajesh Taneja, Hikaru Tomoe, Tomohiro Ueda, Gjertrud Wennevik, Kristene Whitmore, Jean Jacques Wyndaele, Andrew Zaitcev

Department of Urology, Sahlgrenska Academy at the University Gothenburg, Institute of Clinical Sciences, Göteborg, Sweden., Department of Urology, Herlev University Hospital, Copenhagen, Denmark., Female Pelvic Medicine & Reconstructive Surgery Center, Catholic University, Rome, Italy., Department of Urology, Hospital de Sao Joao, University of Porto Faculty of Medicine, Porto, Portugal., The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA., Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Department of Pathology, County Hospital Ryhov, Jönköping, Sweden., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden., International Painful Bladder Foundation, Naarden, The Netherlands., Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad, India., Italian Interstitial Cystitis Association, Rome, Italy., Department of Urology, Small Pelvis Clinic, University Hospital Antwerpen, Antwerp, Belgium., Interstitial Cystitis Association of America, San Jose, CA, USA., Department of Urology, Helsinki University Central Hospital, Helsinki, Finland., Department of Urology and Andrology, Indraprastha Apollo Hospitals, New Delhi, India., Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan., Comfortable Urology Network, Ueda Clinic, Kyoto, Japan., Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark., Department of Urology, Drexel University College of Medicine, Philadelphia, PA, USA., Department of Urology, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium., Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

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