[Bladder pain syndrome].

La Revue du praticien Pub Date : 2025-04-01
Shahed Borojeni, Benoit Peyronnet
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Abstract

BLADDER PAIN SYNDROME. Bladder pain syndrome (BPS), often associated with other pelvic pain syndromes, is defined as perceived chronic pain or discomfort related to the bladder, associated with other urinary symptoms such as pollakiuria or a constant urge to urinate, in the absence of organic pathology. It more often affects women. Assessment is clinical, including a voiding schedule and standardized questionnaires measuring impact on quality of life. The key examination is cystoscopy, under local or general anaesthetic, to rule out the differential diagnosis of bladder tumour and separate VDS into two entities or phenotypes: hypersensitive bladder, with no lesion of the bladder wall, and "interstitial cystitis" with parietal lesion, characterized by the presence of specific histological and sometimes endoscopic lesions such as Hunner's ulcerations. Pathophysiology is thought to differ between these entities, involving multiple factors such as inflammation, autoimmunity, infection, environment, urothelial barrier dysfunction, pelvic or central sensitization and extra-vesical disorders. BPS requires comprehensive, multidisciplinary patient management. The first line of treatment usually includes cystoscopy with hydrodistension in the case of parietal forms, introduction of amitriptyline, physiotherapy, diet and TENS (Transcutaneous Electrical Nerve Stimulation). A better understanding of the underlying mechanisms would enable us to propose an even more individualized treatment, specific to the BPS phenotype.

[膀胱疼痛综合征]。
膀胱疼痛综合征。膀胱疼痛综合征(BPS)常伴有其他盆腔疼痛综合征,定义为在无器质性病理的情况下,与膀胱相关的慢性疼痛或不适,伴有其他泌尿系统症状,如polakiuria或持续的小便冲动。它更常影响女性。评估是临床的,包括排尿时间表和衡量生活质量影响的标准化问卷。关键检查是在局部或全身麻醉下进行膀胱镜检查,以排除膀胱肿瘤的鉴别诊断,并将VDS分为两种实体或表型:超敏性膀胱,无膀胱壁病变,以及“间质性膀胱炎”,伴有膀胱壁病变,其特征是存在特定的组织学病变,有时也有内窥镜病变,如Hunner溃疡。这些实体的病理生理被认为是不同的,涉及多种因素,如炎症、自身免疫、感染、环境、尿路上皮屏障功能障碍、盆腔或中枢致敏和膀胱外疾病。BPS需要全面、多学科的患者管理。治疗的第一线通常包括膀胱镜检查和腹壁形式的水膨胀,引入阿米替林,物理治疗,饮食和TENS(经皮神经电刺激)。更好地了解潜在的机制将使我们能够提出一种更加个性化的治疗方法,针对BPS表型。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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