Bladder pain syndrome

2017 ◽  
Author(s):  
Magnus Fall
Keyword(s):  
Treatment Options ◽  
Correct Diagnosis ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Clinical Syndrome ◽  
Personal Life ◽  
Medical Community ◽  
Bladder Pain ◽  
Profound Impact ◽  
Medical Consultations

Bladder pain syndrome has a profound impact on the patients’ physical, professional, and personal life. Generally, recognition of this clinical syndrome is hampered by insufficient expertise in the medical community. The correct diagnosis is often delayed by several years and may be preceded by multiple medical consultations and treatment attempts. Still, this is one of the most painful, non-malignant conditions to be encountered in urology and it is probably more common than generally believed. Problems as to diagnosis, phenotyping, terminology, and management persist, but during the last few years there has been increasing activity to resolve those issues. In this chapter, symptoms, findings, and treatment options are outlined.

scholarly journals Clinical Remission Using Personalized Low-Dose Intravenous Infusions of N-acetylcysteine with Minimal Toxicities for Interstitial Cystitis/Bladder Pain Syndrome

2021 ◽  
Vol 11 (5) ◽  
pp. 342
Author(s):  
Dipnarine Maharaj ◽  
Gayathri Srinivasan ◽  
Sarah Makepeace ◽  
Christopher J. Hickey ◽  
Jacqueline Gouvea
Keyword(s):  
Adverse Events ◽  
Interstitial Cystitis ◽  
Clinical Remission ◽  
Low Dose ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Infusion Therapy ◽  
Blurred Vision ◽  
Bladder Pain

Interstitial Cystitis or Bladder Pain Syndrome (IC/BPS) is a heterogeneous condition characterized by elevated levels of inflammatory cytokines, IL-1β, IL-6, IL-8, IL-10, TNF-α, and is associated with debilitating symptoms of pelvic pain and frequent urination. A standard of care for IC/BPS has not been established, and most patients must undergo a series of different treatment options, with potential for severe adverse events. Here, we report a patient with a 26-year history of IC/BPS following treatment with multiple therapies, including low doses of etodolac, amitriptyline and gabapentin, which she was unable to tolerate because of adverse effects, including headaches, blurred vision and cognitive impairment. The patient achieved a complete clinical remission with minimal adverse events after 16 cycles of N-acetylcysteine (NAC) intravenous (IV) infusions over a period of 5 months, and pro-inflammatory cytokine levels were reduced when compared to measurements taken at presentation. Personalized low dose NAC IV infusion therapy represents an effective, safe, anti-inflammatory therapy administered in the outpatient setting for IC/BPS, and warrants further investigation.

Association of Elmiron (pentosanpolysulphate sodium) with pigmented maculopathy: An update for urologists and patients

2021 ◽  
pp. 205141582110536
Author(s):  
Mithun Kailavasan ◽  
Jonathan Charles Goddard
Keyword(s):  
Treatment Options ◽  
Pain Syndrome ◽  
Evidence Base ◽  
Bladder Pain Syndrome ◽  
Good Evidence ◽  
Current Evidence ◽  
Exact Nature ◽  
Level Of Evidence ◽  
Bladder Pain ◽  
Number Of Treatment

Introduction: Bladder pain syndrome (BPS) is a difficult disorder to diagnose and manage with a limited number of treatment options that have a good evidence base. Elmiron (pentosanpolysulphate sodium (PPS)) is recognised as a main second-line treatment option in many international guidelines. Recently published retrospective studies suggest that there is an association between Elmiron and pigmented maculopathy, a rare disease associated with visual impairment. Objectives: To review the known literature on Elmiron and pigmented maculopathy and alternative oral pharmacotherapy options for BPS. To promote awareness on this topic and aid urologists in managing Elmiron prescription. Methods: We reviewed the most commonly used oral treatments for BPS, in particular Elmiron, the current evidence to support this association with eye disease and its position in the management pathway of this complex condition. Conclusions: Recent retrospective longitudinal studies have demonstrated an association of Elmiron with pigmented maculopathy. However, as yet the exact nature of this relationship is unknown. Nevertheless, Elmiron remains an important part of the treatment pathway for BPS. We suggest clinicians should fully inform patients of this association, including patients who have been previously comenced on Elmiron. There should be ongoing and continuing reviews of all treatments to review its efficacy in indiviual patients. Level of evidence: Not applicable

scholarly journals Biomarkers in the Light of the Etiopathology of IC/BPS

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2231
Author(s):  
Jochen Neuhaus ◽  
Mandy Berndt-Paetz ◽  
Andreas Gonsior
Keyword(s):  
Treatment Options ◽  
Pain Syndrome ◽  
Genetic Alterations ◽  
Bladder Pain Syndrome ◽  
Virus Infections ◽  
Bladder Pain ◽  
Chronic Urinary Tract Infection ◽  
New Findings ◽  
Close Relationship ◽  
Urinary Microbiome

In this review, we focused on putatively interesting biomarkers of interstitial cystitis/bladder pain syndrome (IC/BPS) in relation to the etiopathology of this disease. Since its etiopathology is still under discussion, the development of novel biomarkers is critical for the correct classification of the patients in order to open personalized treatment options, on the one hand, and to separate true IC/BPS from the numerous confusable diseases with comparable symptom spectra on the other hand. There is growing evidence supporting the notion that the classical or Hunner-type IC (HIC) and the non-Hunner-type IC (NHIC) are different diseases with different etiopathologies and different pathophysiology at the full-blown state. While genetic alterations indicate close relationship to allergic and autoimmune diseases, at present, the genetic origin of IC/BPS could be identified. Disturbed angiogenesis and impairment of the microvessels could be linked to altered humoral signaling cascades leading to enhanced VEGF levels which in turn could enhance leucocyte and mast cell invasion. Recurrent or chronic urinary tract infection has been speculated to promote IC/BPS. New findings show that occult virus infections occurred in most IC/BPS patients and that the urinary microbiome was altered, supporting the hypothesis of infections as major players in IC/BPS. Environmental and nutritional factors may also influence IC/BPS, at least at a late state (e.g., cigarette smoking can enhance IC/BPS symptoms). The damage of the urothelial barrier could possibly be the result of many different causality chains and mark the final state of IC/BPS, the causes of this development having been introduced years ago. We conclude that the etiopathology of IC/BPS is complex, involving regulatory mechanisms at various levels. However, using novel molecular biologic techniques promise more sophisticated analysis of this pathophysiological network, resulting in a constantly improvement of our understanding of IC/BPS and related diseases.

scholarly journals Mirabegron as adjuvant treatment for patients with interstitial cystitis/bladder pain syndrome

2017 ◽  
Vol 12 (3) ◽  
pp. E100-4 ◽  
Author(s):  
Michael Di Lena ◽  
Victoria Tolls ◽  
Kerri-Lynn Kelly ◽  
J. Curtis Nickel
Keyword(s):  
Interstitial Cystitis ◽  
Adjuvant Treatment ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Post Treatment ◽  
Symptom Scale ◽  
Symptom Index ◽  
Bladder Pain ◽  
Significant Difference

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) patients represent a heterogeneous group with pain and urinary storage symptoms and varying responses to current treatment options. The novel beta-3 agonist, mirabegron, has been shown to improve storage symptoms of patients with bladder overactivity; however, its effect on symptoms in the IC/BPS population has yet to be studied.Methods: Patients diagnosed at a single IC centre with IC/BPS undergoing standard therapy were treated with additional daily mirabegron 25 mg and seen in followup post-treatment. Patients completed the Interstitial Cystitis Symptom Index and Problem Index (ICSI/ICPI), and the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF) prior to and following mirabegron treatment. Global (NRS) and symptom-specific outcomes were assessed by comparing the pre- and post-treatment mean scores using tailed-t test (p<0.05 considered statistically significant).Results: A total of 23 patients were available for review pre- and post-mirabegron treatment. There was no significant difference in ICSI (p=0.448), ICPI (p=0.352), or PUF (p=0.869) pre- and post-treatment. Analysis of symptom-specific outcomes show statistically significant improvements in urgency (p=0.048); however, no statistically significant improvements in frequency (p=0.951) or pain (p=0.952) were observed with mirabegron therapy.Conclusions: IC/BPS patients treated with mirabegron had improvement of urinary urgency, but no significant benefit in terms of pain or urinary frequency. This data suggests that mirabegron’s role in the IC/BPS patient should be that of adjuvant treatment to ameliorate urgency.

scholarly journals Management of Bladder Pain Syndrome (BPS): A Practical Guide

2022 ◽  
Vol 2022 ◽  
pp. 1-9
Author(s):  
Patrick Juliebø-Jones ◽  
Karin M. Hjelle ◽  
Jannike Mohn ◽  
Gigja Gudbrandsdottir ◽  
Ingunn Roth ◽  
...  
Keyword(s):  
Patient Care ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Holistic Approach ◽  
Bladder Pain Syndrome ◽  
Refractory Disease ◽  
Bladder Pain ◽  
Bladder Instillation ◽  
Real Challenge ◽  
Test Finding

Bladder pain syndrome (BPS) is a prevalent and pervasive disease. The physical and psychological sequelae can be very burdensome for the patient, and the condition represents a real challenge for the clinician as well. With no simple pathognomonic test, finding harmony in navigating patient care can be demanding. Diagnosis and management rely upon a multidisciplinary and holistic approach. Treatment options include conservative measures and pharmacotherapies as well as bladder instillation therapies. Ultimately, surgery may be offered but only in cases of refractory disease. This article offers a pragmatic guide for clinicians managing this challenging disease.

Assessing the Efficacy of Superior Hypogastric Nerve Block as a Possible Treatment Option for Bladder Pain Syndrome

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Smith D ◽  
◽  
Patel R ◽  
Hunter K ◽  
Sabia M ◽  
...  
Keyword(s):  
Nerve Block ◽  
Pelvic Pain ◽  
Treatment Options ◽  
Alternative Therapy ◽  
Previous Treatment ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Bladder Pain ◽  
Significant Difference ◽  
Pain Improvement

Introduction: Chronic pelvic pain (CPP), and its subtype of interstitial cystitis/bladder pain syndrome (IC/BPS) can be debilitating and difficult conditions to treat. A new treatment modality being explored is the superior hypogastric (plexus) nerve block (SHPB). While previously indicated to relieve conditions related to chronic abdominal and pelvic pain, there is a paucity of evidence for use in IC/BPS patients. We aim to explore the efficacy of SHPB therapy in this population. Methods: This is a retrospective, single institution study including patients with IC/BPS or CPP who underwent SHPB during a 7-year span. Parameters analyzed include number of treatments, percentage of pain improvement after treatment, and multiple demographic and disease variables. Results: A total of 30 patients (26 CPP; 4 IC/BPS) were included in the study and 80% completed pain scores after their first injection (n=24). Fourteen patients had >50% pain improvement (58.3%), 10 had >70% improvement (41.7%) and 5 patients had 100% improvement (20.8%) after their first injection. Greater pain improvement was seen in the multiple vs. single injection group (52.3% vs. 20.8%, p=0.013). There was no significant difference in pain improvement between CPP and IC/BPS groups (42.2% vs. 50.0%, p= 0.630). Conclusion: SHPB may be useful as an alternative therapy for IC/BPS patients who have failed previous treatment options. Additional high-powered studies are needed to validate the safety and efficacy of SHPB in this population.

scholarly journals Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Contemporary Review

2020 ◽  
Keyword(s):  
Interstitial Cystitis ◽  
Negative Impact ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Female Population ◽  
Bladder Pain ◽  
Urinary Tract Symptoms ◽  
Surgical Options ◽  
American Urological Association

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition affecting approximately 3% of the female population. IC/BPS is defined as an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than six weeks duration, in the absence of infection or other identifiable cause. This condition is known to have a profound negative impact on quality of life. There are few well-studied treatment options and no cure for this condition, which is therefore challenging to treat. The purpose of this narrative review is to summarise the contemporary literature, including the Canadian Urological Association (CUA) and American Urological Association (AUA) guidelines, on various treatment options that exist for IC/BPS, including conservative therapies, oral therapies, intravesical therapies, and more invasive surgical options. Most importantly, this review highlights the need for an individualised, multimodal approach to the treatment of IC/BPS.

scholarly journals Current standard of care in treatment of bladder pain syndrome/interstitial cystitis

2021 ◽  
Vol 13 ◽  
pp. 175628722110224
Author(s):  
Sabela Rodriguez Lopez ◽  
Naşide Mangır
Keyword(s):  
Interstitial Cystitis ◽  
Cell Activation ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Mast Cell Activation ◽  
Relaxation Techniques ◽  
Level Of Evidence ◽  
Bladder Pain ◽  
Cardinal Symptom

Bladder pain syndrome/interstitial cystitis (BPS/IC) is a debilitating, systemic pain syndrome with a cardinal symptom of bladder related pain with associated systemic symptoms. It is characterized by an inflammation that partially or completely destroys the mucus membrane and can extend into the muscle layer; however, the etiology and pathogenesis is still enigmatic. It has been suggested that mast cell activation, defects in the glycosaminoglycan layer, non-functional proliferation of bladder epithelial cells, neurogenic inflammation, microvascular abnormalities in the submucosal layer, autoimmunity and infectious causes may cause BPS/IC. Available treatment options include general relaxation techniques, patient education, behavioral treatments, physical therapy, multimodal pain therapy, oral (amitriptyline, cimetidine, hydroxyzine) and intravesical treatments (heparin, lidocaine, hyaluronic acid and chondroitin sulfate), hydrodistension and other more invasive treatments. Available treatments are mostly not based on a high level of evidence. Lack of understanding of disease mechanisms has resulted in lack of targeted therapies on this area and a wealth of empirical approaches with usually inadequate efficacy. The aim of this article is to review the available evidence on the pathophysiological mechanisms of BPS/IC as they relate to available treatment options.

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