Traitements spécifiques du syndrome douloureux vésical

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

Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome.

Background: Bladder pain syndrome (BPS) is a chronic condition characterized by pelvic pain and lower urinary tract symptoms. Pentosan polysulfate sodium (PPS) is the only oral therapy licensed in the United Kingdom (UK) for BPS; however, evidence on its effectiveness is inconsistent, with limited data for off-label use in ketamine- or radiation-induced cystitis. Objective: This study evaluates real-world outcomes of PPS in patients with BPS and other chronic bladder pain at a UK tertiary center. Methods: A retrospective review included 42 patients prescribed PPS between 2020 and 2024 for BPS (n = 29), ketamine-induced cystitis (n = 9), or radiation/chemotherapy-induced cystitis (n = 4), excluding Bacillus Calmette–Guérin cystitis. Demographics, comorbidities, prior treatments, symptom severity, and treatment response were recorded. Changes in quality of life (QoL) and Interstitial Cystitis Symptom Index/Interstitial Cystitis Problem Index (ICSI/ICPI) scores were analyzed using the Wilcoxon signed-rank test and one-way analysis of variance. Results: The mean age was 49.7 years, and 81% were female, with a median follow-up of 15.3 months. All patients were severely symptomatic at baseline. Among those with follow-up data, 42.5% were asymptomatic, 25% mildly symptomatic, and 32.5% remained severely symptomatic. QoL improved significantly (Wilcoxon Z = −4.71, p<0.001). Greatest reductions in ICSI and ICPI scores were observed in BPS patients, with modest improvements in off-label groups. Side effects occurred in 14.2% of patients. PPS was associated with significant symptom improvement and acceptable tolerability in a treatment-refractory cohort, particularly in BPS. Conclusion: Modest benefits in ketamine- and radiation-induced cystitis suggest potential off-label utility, warranting further investigation. These findings support PPS use in selected cases, while accounting for placebo effects and disease heterogeneity.

UP-01.110 The Effect of Botulinum Toxin A in Treatment of Painful Bladder Syndrome

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.

Open Label, Pilot Evaluation of the Safety and Efficacy of Intravesical Sustained Release System of Lidocaine and Oxybutynin (TRG-100) for Patients With Interstitial Cystitis/Bladder Pain Syndrome, Overactive Bladder and Patients With Retained Ureteral Stents Following Endourological Interventions

Interstitial cystitis/bladder pain syndrome (IC/BPS) is often associated with vulvodynia and poor vaginal health. IC/BPS causes pelvic and bladder pain and urinary symptoms, which considerably reduce the quality of life. To date, this condition has no definitive cure. Local estrogen therapy (LET) has been proposed as a treatment for vulvodynia and poor vaginal health to improve the symptoms of IC/BPS. However, chronic LET could be contraindicated or not desired in some patients. The present study reports the case of a 55-year-old postmenopausal woman with IC/BPS who was successfully treated with combined vaginal erbium (VEL)/neodymium (Nd:YAG) laser (VEL+Nd:YAG) therapy. The patient presented with a five-year history of pelvic pain and urinary frequency. Direct approaches for the bladder (such as hydrodistension, anticholinergic drugs, and transurethral Hunner lesion ablation/cauterization) were conducted with inconsistent results. Immediately prior to the patient’s presentation, LET was administered for 12 weeks; however, this therapy resulted in mild improvement and poor patient satisfaction. After presentation, VEL+Nd:YAG therapy was conducted once a month for three months. The patient reported considerable decrease in pain during urination. The improved symptoms were maintained for six months after the last therapy session. These results suggest that VEL+Nd:YAG therapy is an effective method for improving symptoms in patients with IC/BPS.

Pentosan Polysulfate (PPS) is the only oral treatment for interstitial cystitis (IC)-bladder pain syndrome (BPS) approved by the World Health Organization. Self-evaluation scales can provide more objective results on pre- and post-treatment satisfaction. The aim of this study was to investigate the effect of pentosan polysulfate treatment on symptoms in IC-BPS patients. This study included 37 adult male and female patients with IC-BPS who reported pain, urinary urgency, polyurea, and nocturia without urinary tract infection for a minimum of six months prior to the study and were taking 300 mg/day oral pentosan polysulfate. Pre- and post-treatment symptoms, Interstitial Cystitis Symptom Index (ICSI) Scores, quality of life (QoL) scores (1-4), and satisfaction conditions were examined. Following the application of inclusion and exclusion criteria, mean age of 37 suitable patients was 46.0±11.9 years and 27% (10 individuals) of the patients were male. Pre-treatment, ICSI scores, and measures of satisfaction degree and QoL increased significantly after the treatment (p<0.001). Adverse reaction was detected in two patients (5.4%) among the patients treated with pentosan polysulfate. Oral pentosan polysulfate for the treatment of interstitial cystitis/bladder pain syndrome treatment could achieve recovery in symptoms, increase Interstitial Cystitis Symptom Index score and improve quality of life and patient satisfaction.

Interstitial cystitis: a phenotype and rare variant exome sequencing study.

MP08-07 THE IMPORTANCE OF WIDESPREAD PAIN IN TREATMENT RESPONSE FOR PAIN AND URINARY SYMPTOMS IN INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS)

Study Type--Diagnostic (symptom prevalence). Level of Evidence 2b. What's known on the subject? And what does the study add? Symptom variability is profound in the population of patients diagnosed with interstitial cystitis and painful bladder syndrome because these diagnoses represent a very heterogeneous patient population. Recently, younger patients are being diagnosed with these pain syndromes, without any specific investigation into the symptoms they experience. We identified that patients diagnosed with interstitial cystitis and painful bladder syndrome have variable clinical symptom profiles depending on the age at the time of their diagnosis. Dyspareunia, external genitalia pain, urgency, frequency and dysuria were more common in younger patients whereas nocturia, urinary incontinence and the presence of Hunner's ulcers were more common in older patients. Better defining symptom profiles for patients at the time of evaluation may potentially aid in more accurate and expedited diagnosis of these conditions, particularly in the youngest patient population which is being recognized more commonly in recent times. • To investigate the clinical profile differences among patients with interstitial cystitis/painful bladder syndrome (IC/PBS) based upon age at the time of diagnosis from childhood into the geriatric age group. • An analysis of 268 patients with IC/PBS seen between 1990 and 2008 was performed. • Three age cohorts were analysed: <30 years, ≥30 years but <60 years, and ≥60 years of age at time of diagnosis. • Patient demographics, disease characteristics and IC/PBS-associated symptoms were compared across the three groups. • Of the 268 patients, 60 were <30 years of age at the time of IC diagnosis (median 22, range 11-29), 105 were ≥30 but <60 years (median 48, range 30-59) and 103 patients were ≥60 years of age (median 69, range 60-88). • Of the patients in the youngest, middle and oldest age cohorts: 12.0, 42.0 and 39.8% had Hunner's ulcers, respectively (P<0.001). • Dyspareunia and external genitalia pain were more common in the youngest age cohort, P<0.001 and P=0.001, respectively. • Urinary urgency (P=0.033), frequency (P=0.006) and dysuria (P<0.001) were also more common in patients diagnosed before 30 years of age. • The reported rate of nocturia and urinary incontinence increased with age, P=0.002 and P<0.001, respectively. • Patients with IC/PBS analysed across a wide spectrum of ages at time of diagnosis portrayed a unique symptom profile pattern. • Patients diagnosed at the youngest ages experienced significantly more urinary urgency, frequency, dysuria, dyspareunia and pain in their external genitalia. • Older patients had higher rates of nocturia, urinary incontinence and Hunner's ulcer disease.

Objectives:Hysterectomies may be performed unnecessarily in women with chronic pelvic pain if the diagnosis of interstitial cystitis is not considered. The objectives of this study were to investigate the prevalence of interstitial cystitis in patients with posthysterectomy chronic pelvic pain and to evaluate the efficacy of various therapies for interstitial cystitis.Methods:A study was performed of 111 patients with chronic pelvic pain whose pain persisted after hysterectomy. Patients were screened with the Pelvic Pain and Urgency/Frequency symptom scale, and underwent Potassium Sensitivity Testing. Patients were treated with dietary changes alone or in combination with cystoscopic hydrodistention or oral pentosan polysulfate, or both of these, for 3 to 6 months.Results:Of the 111 patients enrolled, 79% (n=88) were diagnosed with bladder dysfunction consistent with interstitial cystitis. For patients treated with dietary modification alone (n=33), the mean score on the Pelvic Pain and Urgency/Frequency questionnaire improved 15.4%, from 13.18 at baseline to 11.15 at follow-up. For patients treated with pentosan polysulfate or cystoscopic hydrodistention, or both, plus diet changes (n=78), Pelvic Pain and Urgency/Frequency scores improved 34.2%, from 15.01 to 9.87.Conclusion:In this study, nonsurgical treatment for interstitial cystitis resulted in a marked improvement in symptoms that had not improved with surgery. Without determining the origin of bladder pain, gynecologists should not proceed to hysterectomy in patients with chronic pelvic pain.

Transient Receptor Potential Vanilloid Receptor Subtype 1 in Painful Bladder Syndrome and its Correlation With Pain

Bladder pain syndrome: Long-term results (15years) of a single-center experience

IntroductionWe describe a novel colopathy associated with pentosan polysulfate (PPS) use and assess the strength of the drug-disease association in a two-part investigation.Methods1. Cohort Study: We studied individuals with a history of long-term PPS use. Case histories concerning gastrointestinal disease were obtained with review of endoscopy records and histopathology specimens. Findings were summarized with descriptive statistics. 2. Cross-Sectional Study: We evaluated patients with interstitial cystitis at a single clinical center. We obtained data on drug exposure and medical histories and measured the strength of association between PPS use and diagnosis of inflammatory bowel disease (IBD) using multivariate logistic regression.Results1. Cohort Study: Among 13 participants, the median PPS exposure was 2.04 kg (range 0.99–2.54 kg). Eleven participants (84.6%) developed IBD symptomatology after initiating PPS therapy, and 9 (69.2%) were diagnosed with IBD. Two others (18%) were diagnosed with irritable bowel syndrome. Of the 10 participants with endoscopic and histopathologic data, six had abnormal colonic mucosa on endoscopy, and all 10 had histologic abnormalities. Clinical and histologic improvement was noted after PPS cessation, though two (18%) required colectomy for colitis-associated dysplasia. 2. Cross-Sectional Study: Among 219 subjects with interstitial cystitis, PPS use was a statistically significant predictor of an IBD diagnosis, with an adjusted odds ratio of 3.3 (95% confidence interval, 1.2–8.8, p = 0.02).DiscussionOur study identifies a strong association between PPS use and clinical diagnosis of IBD. Histopathologic findings suggest a novel drug-associated colopathy, with some subjects necessitating colectomy for dysplasia. Further investigation into the causality of this association is warranted.