Correlation between cystoscopy findings and symptom severity in painful bladder syndrome

Urinary Tract Infection and Inflammation at Onset of Interstitial Cystitis/Painful Bladder Syndrome

Introduction: Interstitial cystitis or bladder pain syndrome (IC/BPS) is a debilitating chronic disease characterized by suprapubic pain and lower urinary tract symptoms: however, the etiology is still unknown. Therefore, the long-lasting, effective treatments of IC/BPS are still not established, and the treatment is sometimes empirically selected depending on practitioners’ experience and preference.Area covered: In this review we focus on the current treatments, ongoing clinical trials, and several potential new drugs based on the results of basic and clinical research studies. First, we discuss the potential etiologies of IC/BPS that include altered barrier lining, afferent and/or central nervous system abnormalities, possible contribution of inflammation or infection and abnormal urothelial signaling. Then, the current therapies of IC/BPS, either systemic or local, are reviewed by critical evaluation of the efficacy and shortcomings of each treatment. Finally, based on proposed etiologies of the disease, potential emerging drugs and treatments are discussed.Expert opinion: Current therapies often fail to control the symptoms of IC/BPS. Several interventions including sustained drug release and retaining techniques, and drugs that act on afferent neural pathways are emerging and may be promising. In addition, phenotyping of IC/BPS patients based on cystoscopic findings (e.g., Hunner vs. non-Hunner lesion) or patients’ symptoms would be important for further investigation of IC/BPS etiology and the evaluation of efficacy of new treatments.

INTERSTITIAL CYSTITIS, CHRONIC NONBACTERIAL PROSTATITIS AND CHRONIC PELVIC PAIN SYNDROME IN MEN: A COMMON AND FREQUENTLY IDENTICAL CLINICAL ENTITY

MP18-07 ASSESSMENT OF BLADDER “PRESSURE” AND “DISCOMFORT” SYMPTOMS—HOW DO OVERACTIVE BLADDER DIFFER FROM INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME PATIENTS?

A RANDOMIZED DOUBLE-BLIND TRIAL OF ORAL L-ARGININE FOR TREATMENT OF INTERSTITIAL CYSTITIS

The Severity and Distribution of Nonurologic Pain and Urogenital Pain in Overactive Bladder are Intermediate Between Interstitial Cystitis and Controls

Purpose: Currently, there is no effective and durable treatment for all patients with interstitial cystitis/bladder pain syndrome (IC/BPS). It is possible that multiple pathophysiologies underlie this disease. This study investigated the association between clinical parameters and urine biomarkers and overall treatment outcomes in women with IC/BPS. Methods: Women with IC/BPS were retrospectively included in this study. The clinical symptoms, videourodynamic study, cystoscopic features under anesthesia, and urinary inflammatory and oxidative stress biomarkers were investigated and compared between patients who were satisfactory or unsatisfactory to different bladder therapy for IC/BPS. The clinical parameters were searched for predicting a satisfactory treatment outcome. Results: A total of 315 IC/BPS patients including 291 non-Hunner IC (NHIC) and 24 Hunner IC were included, with a mean age of 53.3 ± 13.3 years and a median follow-up period of 10 years. Among the NHIC patients, 167 (57.4%) had a satisfactory outcome (GRA 2 or 3) after treatment. NHIC patients with a baseline larger maximal bladder capacity in hydrodistention and larger first sensation of filling in videourodynamic study predict a satisfactory outcome after different bladder therapy. The urinary levels of lower C-X-C motif chemokine ligand 10, 8-hydroxydeoxyguanosine, and 8-isoprostane also predict a satisfactory treatment outcome in patients with NHIC. Conclusion: The results of this study revealed that patients with NHIC and had a larger first sensation of filling, maximal bladder capacity, lower urinary levels of C-X-C motif chemokine ligand 10, 8-hydroxydeoxyguanosine, and 8-isoprostane might have a satisfactory outcome, indicating less bladder inflammation might have a better treatment result.

Background Irritable Bowel Syndrome (IBS) is a functional ailment of the intestines characterized by altered defecation and abdominal irritation in the absence of detectable structural disorders. Aim The aim of the present study was to determine the association between marital satisfaction and the severity of symptoms in patients with IBS. Methods This is a cross-sectional study, which was conducted using available sampling on 77 IBS patients who were referred to internal specialists in specialized clinics in Jiroft City in 2022. Data were collected using IBS symptom severity and marital satisfaction questionnaires and analyzed using SPSS-22 statistical software and descriptive and inferential statistical tests. Results The severity of IBS symptoms had significant differences at different levels of three sub-criteria of the extent of marital satisfaction, level of satisfaction in marital relationships, and idealistic distortion of individuals in their marital life. However, this correlation was not significant in the sub-criterion of marital conflict resolution. Consequently, as a stressor, the level of marital satisfaction had a negative correlation with patients’ severity of symptoms. Conclusion The more severe the IBS symptoms, the higher the effect of psychological factors. Furthermore, the more severe the stress, the higher its effect on the severity of IBS symptoms. Managing problems in marital life can help control IBS symptoms. Paying attention to the problems of married life as a stressor in IBS patients by doctors and the cooperation of the treating doctor with psychologists in the treatment process of these patients can help in controlling the symptoms of these patients.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a common and debilitating disease with poor treatment outcomes. Studies from the multidisciplinary approach to the study of chronic pelvic pain research network established that IC/BPS patients with chronic overlapping pain conditions (COPCs) experience poorer quality of life and more severe symptoms, yet the neurobiological correlates of this subtype are largely unknown. We previously showed that ex vivo toll-like receptor 4 (TLR4) cytokine/chemokine release is associated with the presence of COPCs, as well as widespread pain and experimental pain sensitivity women with IC/BPS. Here, we attempt to confirm these findings in the multisite multidisciplinary approach to the study of chronic pelvic pain Symptom Patterns Study using TLR4-stimulated whole blood (female IC/BPS patients with COPC n = 99; without n = 36). Samples were collected in tubes preloaded with TLR4 agonist, incubated for 24 hours, and resulting supernatant assayed for 7 cytokines/chemokines. These were subject to a principal components analysis and the resulting components used as dependent variables in general linear models. Controlling for patient age, body mass index, and site of collection, we found that greater ex vivo TLR4-stimulated cytokine/chemokine release was associated with the presence of COPCs ( P < 0.01), extent of widespread pain ( P < 0.05), but not experimental pain sensitivity ( P > 0.05). However, a second component of anti-inflammatory, regulatory, and chemotactic activity was associated with reduced pain sensitivity ( P < 0.01). These results confirm that the IC/BPS + COPCs subtype show higher levels of ex vivo TLR4 cytokine/chemokine release and support a link between immune priming and nociplastic pain in IC/BPS.

Inflammation and inflammatory control in interstitial cystitis/bladder pain syndrome: Associations with painful symptoms

Traditional Chinese medicine (TCM) is commonly used for urinary symptoms in Eastern countries. Since there are few effective treatments available for patients with interstitial cystitis/bladder pain syndrome (IC/BPS), the psychological burden leads to increased healthcare-seeking behavior. Some patients may therefore seek TCM treatment for related urinary symptoms. Due to limited clinical research evaluating the effects of TCM on IC/BPS, we conducted a nationwide population-based cohort study to investigate the relationship between TCM and mental disorders among these patients. The IC/BPS cohort and its matched non-IC/BPS comparison cohort were recruited from the National Health Insurance (NHI) Research Database between 2000 and 2011. Patients with the use of Chinese herbal medicine (CHM) granules or acupuncture over 90 days per year were enrolled as the TCM users. Multivariable Cox proportional hazards models were used to evaluate the hazard ratio (HR) of mental disorders related to interstitial cystitis. The incidence of mental disorders in the 2 cohorts was assessed with Kaplan–Meier curves. A total of 1123 patients with IC/BPS and 4492 matched non-IC/BPS subjects were included in this study. The IC/BPS cohort demonstrated higher incidence rate of mental disorders than the cohort without IC/BPS (adjusted HR: 2.21, 95% confidence interval [CI]: 1.73–2.81). There was no statistically significant difference in the risk of mental disorders between IC/BPS patients with and without CHM granules or acupuncture treatment (adjusted HR: 0.99, 95% CI: 0.58–1.68). Our results indicated that CHM and acupuncture showed insignificant efficacy in the prevention of mental disorders in IC/BPS patients.

Urinary and psychological outcomes in women with interstitial cystitis/bladder pain syndrome following hyaluronic acid treatment

Interstitial cystitis/bladder pain syndrome (IC/BPS) is an umbrella term of chronic debilitating conditions of unknown etiology characterized by symptoms of lower urinary tract hypersensitivity such as bladder pain/discomfort, urgency, and urinary frequency. The pathological features of IC/BPS have been generally reported as non-specific chronic inflammatory changes, with mast cell infiltration as a potential key finding. However, growing evidence reveals a histological distinction between IC/BPS with Hunner lesions and IC/BPS without Hunner lesions, and also sheds doubt on the diagnostic value of the mast cell count. Specifically, IC/BPS with Hunner lesions is an inflammatory disorder characterized by pancystitis with B cell abnormalities and epithelial denudation, while IC/BPS without Hunner lesions shows minimal histological changes. The umbrella term "IC/BPS" connects totally distinct clinical entities. Pathological evaluation thus plays an important role in the precise subtyping and clinical management of IC/BPS. In addition, terminology should be developed to refer separately to IC/BPS with Hunner lesions and IC/BPS without Hunner lesions.

The aim of this study was to clarify the prevalence of painful bladder syndrome (PBS) symptoms in adult women in the general population in Japan. Web-based survey through an internet-based market research company that enrolled 561,631 men and women in Japan was conducted from January 9 to January 11, 2007. After the women allocated to four age groups; 20s, 30s, 40s, and 50s or older, a total of 80,367 women, comprising an almost equal number from each age group, were then randomly invited to participate. The O'Leary and Sant symptom index was used as the questionnaire. The following classification was defined on the basis of the total points score: 0 to 3 points for negligible PBS symptoms, 4 to 6 points for mild symptoms, 7 to 11 points for moderate symptoms, and 12 to 20 points for severe symptoms. A category of possible cases of PBS was defined as severe PBS symptoms including nocturia (twice or more) and pain (2 points or more). A total of 32,074 women ranging in age from 20 to 88 years participated. 76.6% of respondents had negligible PBS symptoms, 17.3% had mild symptoms, 5.6% had moderate symptoms, and 0.5% had severe symptoms, respectively. The incidence rate of women with possible cases of PBS was 0.265% (85/32,074). Comparison with previous reports revealed no difference in the prevalence of PBS symptom in adult women in the general population between Japan and Western countries.

PurposeThis study aimed to determine whether urinary secretory immunoglobulin A (sIgA) levels differ between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and healthy controls, and to assess whether urinary sIgA is linked to mucosal immune mechanisms that may contribute to BPS/IC pathophysiology.MethodsA single-center, cross-sectional study was conducted between April and June 2020 at the Department of Urology, Ege University Faculty of Medicine. Forty female patients with BPS/IC and 40 healthy controls were enrolled. Symptom severity in the BPS/IC group was evaluated using the O’Leary-Sant Interstitial Cystitis Symptom and Problem Index. Patients with active urogenital infections, a history of bladder cancer, or prior pelvic radiotherapy were excluded. Urine samples were collected in sterile containers, centrifuged, and stored at -80°C before sIgA measurement using a commercial enzyme-linked immunosorbent assay kit. Correlations between continuous variables were examined with Spearman rank correlation coefficients.ResultsUrinary sIgA levels were not significantly different between the BPS/IC group (mean±standard deviation: 0.96±1.5 μg/mL) and healthy controls (0.53±0.7 μg/mL) (P=0.173). Subgroup analyses within the BPS/IC cohort showed that smokers had significantly lower urinary sIgA levels (median [range], 0.001 [0.000–0.082] μg/mL) compared with nonsmokers (median [range], 0.720 [0.000–6.850] μg/mL) (P=0.004). Conversely, patients with cardiac comorbidities had significantly higher urinary sIgA levels (median [range], 0.820 [0.100–6.850] μg/mL) than those without cardiac disease (median [range], 0.213 [0.000–2.300] μg/mL) (P=0.015).ConclusionsAlthough no significant differences in urinary sIgA levels were observed between BPS/IC patients and healthy controls, subgroup analyses identified associations with smoking and cardiac comorbidities. These findings suggest that sIgA may be relevant to BPS/IC pathophysiology and highlight the potential of mucosal immune biomarkers. Larger studies are warranted to further clarify the role of sIgA in BPS/IC.