Definition Change and Update of Clinical Guidelines for Interstitial Cystitis and Bladder Pain Syndrome

IF 1.5 4区 医学 Q3 UROLOGY & NEPHROLOGY
Yukio Homma, Yoshiyuki Akiyama, Jang Hwan Kim, Yao-Chi Chuang, Seong Jin Jeong, En Meng, Takeya Kitta, Jia-Fong Jhang, Akira Furuta, Kyu-Sung Lee, Daichi Maeda
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Abstract

The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.

间质性膀胱炎和膀胱疼痛综合征的定义变更和临床指南更新
间质性膀胱炎(IC)和膀胱疼痛综合征(BPS)的临床指南已经修订,更新了我们之前的指南。间质性膀胱炎和膀胱疼痛综合征的症状统称为高敏感性膀胱(HSB)症状,两者几乎没有区别;但是,间质性膀胱炎和膀胱疼痛综合征应被视为不同的疾病。我们将 IC 定义为伴有 Hunner 病变的膀胱疾病,通常伴有 HSB 症状和膀胱炎症;将 BPS 定义为伴有 HSB 症状但无 Hunner 病变和任何可混淆疾病的情况。IC 和 BPS 的病理生理学完全不同。IC 涉及可能由自身免疫引起的免疫性炎症,而 BPS 则与神经源性炎症、外源性物质、尿道缺陷、心理压力和神经亢进等多种因素的相互作用有关。IC 和 BPS 的组织病理学也有所不同。IC 与整个膀胱的严重炎症有关,伴有浆细胞浸润和尿路上皮变性,而 BPS 几乎没有病理变化。治疗应从鉴别诊断 IC 或 BPS 开始,这需要进行膀胱镜检查以确定是否存在 Hunner 病变。虽然 IC 和 BPS 的疼痛治疗方法相同,但患者应根据诊断结果按照算法进行不同的治疗。临床研究也应针对 IC 和 BPS 分别进行设计和分析。
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来源期刊
LUTS: Lower Urinary Tract Symptoms
LUTS: Lower Urinary Tract Symptoms UROLOGY & NEPHROLOGY-
CiteScore
3.00
自引率
7.70%
发文量
52
审稿时长
>12 weeks
期刊介绍: LUTS is designed for the timely communication of peer-reviewed studies which provides new clinical and basic science information to physicians and researchers in the field of neurourology, urodynamics and urogynecology. Contributions are reviewed and selected by a group of distinguished referees from around the world, some of whom constitute the journal''s Editorial Board. The journal covers both basic and clinical research on lower urinary tract dysfunctions (LUTD), such as overactive bladder (OAB), detrusor underactivity, benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO), urinary incontinence, pelvic organ prolapse (POP), painful bladder syndrome (PBS), as well as on other relevant conditions. Case reports are published only if new findings are provided. LUTS is an official journal of the Japanese Continence Society, the Korean Continence Society, and the Taiwanese Continence Society. Submission of papers from all countries are welcome. LUTS has been accepted into Science Citation Index Expanded (SCIE) with a 2011 Impact Factor.
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