The clinical guidelines for interstitial cystitis and related symptomatic conditions were revised by updating our previous guidelines. The current guidelines define interstitial cystitis/bladder pain syndrome as a condition with chronic pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by other urinary symptoms, such as persistent urge to void or urinary frequency in the absence of confusable diseases. The characteristic symptom complex is collectively referred as hypersensitive bladder symptoms. Interstitial cystitis/bladder pain syndrome is divided into Hunner-type interstitial cystitis and bladder pain syndrome; Hunner-type interstitial cystitis and bladder pain syndrome represent interstitial cystitis/bladder pain syndrome with Hunner lesions and interstitial cystitis/bladder pain syndrome without Hunner lesions, respectively. So-called non-Hunner-type interstitial cystitis featured by glomerulations or bladder bleeding after distension is included in bladder pain syndrome. The symptoms are virtually indistinguishable between Hunner-type interstitial cystitis and bladder pain syndrome; however, Hunner-type interstitial cystitis and bladder pain syndrome should be considered as a separate entity of disorder. Histopathology totally differs between Hunner-type interstitial cystitis and bladder pain syndrome; Hunner-type interstitial cystitis is associated with severe inflammation of the urinary bladder accompanied by lymphoplasmacytic infiltration and urothelial denudation, whereas bladder pain syndrome shows little pathological changes in the bladder. Pathophysiology would also differ between Hunner-type interstitial cystitis and bladder pain syndrome, involving interaction of multiple factors, such as inflammation, autoimmunity, infection, exogenous substances, urothelial dysfunction, neural hyperactivity and extrabladder disorders. The patients should be treated differently based on the diagnosis of Hunner-type interstitial cystitis or bladder pain syndrome, which requires cystoscopy to determine the presence or absence Hunner lesions. Clinical studies are to be designed to analyze outcomes separately for Hunner-type interstitial cystitis and bladder pain syndrome.
International journal of urology : official journal of the Japanese Urological Association. 2020 Apr 14 [Epub ahead of print]
Yukio Homma, Yoshiyuki Akiyama, Hikaru Tomoe, Akira Furuta, Tomohiro Ueda, Daichi Maeda, Alex Tl Lin, Hann-Chorng Kuo, Ming-Huei Lee, Seung-June Oh, Joon Chul Kim, Kyu-Sung Lee
Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan., Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan., Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan., Department of Urology, Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Ueda Clinic, Kyoto, Japan., Department of Clinical Genomics, Graduate School of Medicine, Osaka University, Osaka, Japan., Department of Urology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan., Department of Urology, School of Medicine, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan., Department of Urology, Feng-Yuan Hospital, Taichung, Taiwan., Department of Urology, Seoul National University, Seoul, Korea., Department of Urology, The Catholic University of Korea, Seoul, Korea., Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.