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

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.

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Clinical comparision of intravesical hyaluronic acid and hyaluronic acid-chondroitin sulphate therapy for patients with bladder pain syndrome/interstitital cystitis

Canadian Urological Association Journal ◽

10.5489/cuaj.2036 ◽

2014 ◽

Vol 8 (9-10) ◽

pp. 610 ◽

Cited By ~ 15

Author(s):

Ömer Gülpınar ◽

Aytaç Kayış ◽

Evren Süer ◽

Mehmet İlker Gökçe ◽

Adil Güçal Güçlü ◽

...

Keyword(s):

Hyaluronic Acid ◽

Interstitial Cystitis ◽

Chondroitin Sulphate ◽

Sodium Hyaluronate ◽

Previous Treatment ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Symptom Index ◽

Bladder Pain ◽

Significant Difference

Introduction: Patients with a history of bladder pain syndrome/interstitial cystitis (BPS/IC) and who responded poorly or unsatisfactorily with previous treatment were compared taking intravesical hyaluronic acid (HA) or hyaluronic acid-chondroitin sulphate (HA-CS).Methods: Patients were treated with intravesical instillation with 50 mL sterile sodium hyalurinic acid (Hyacyst, Syner-Med, Surrey, UK) (n = 32) and sodium hyaluronate 1.6% sodium chondroitin sulphate 2% (Ialuril, Aspire Pharma, UK) (n = 33). Intravesical instillations were performed weekly in first month, every 15 days in the second month and monthly in third and fourth months, for a total of 8 doses. Patients were evaluated using a visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), voiding diary for frequency/nocturia, cystometric bladder capacity and voided volume at the beginning and at 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis.Results: In total, 53 patients met the study criteria. There were 30 patients in the HA-CS group (mean age: 48.47) and 23 patients in the HA group (mean age: 49.61) (p > 0.05). The initial PST was positive in 71.7% patients (38/53) overall with no difference between groups (p > 0.05). Responses for VAS, ICCS, ICPS, 24-hour frequency/nocturia statistically improved in both groups at 6 months. There was no significant difference in symptomatic improvement (p > 0.05). Eight patients had mild adverse events.Conclusion: HA and HA/CS instillation can be effective in BPS/IC patients who do not respond to conservative treatment. An important limitation of our study is that the HA dosage of the 2 treatment arms were different. It would be more appropriate with same HA dosage in both groups; however, there was no commercially available glycosaminoglycan (GAG) substance with same HA dosage for single and combination therapy. Large, long-term randomized studies are required to determine if there is a difference between these treatments.

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

Canadian Urological Association Journal ◽

10.5489/cuaj.4325 ◽

2017 ◽

Vol 12 (3) ◽

pp. E100-4 ◽

Cited By ~ 2

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.

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Immune Cell Profiles and Cytokine Levels of Patients with Interstitial Cystitis/Bladder Pain Syndrome

10.1101/2020.12.17.20248414 ◽

2020 ◽

Author(s):

Robert M. Moldwin ◽

Vishaan Nursey ◽

Oksana Yaskiv ◽

Siddhartha Dalvi ◽

Michael Funaro ◽

...

Keyword(s):

Interstitial Cystitis ◽

Plasma Cells ◽

Immune Cell ◽

Pain Syndrome ◽

Fold Increase ◽

Bladder Pain Syndrome ◽

Bladder Tissue ◽

Bladder Pain ◽

Tnf Α ◽

Significant Difference

AbstractAimsTo quantify the number of immune cells in the bladder urothelium and concentrations of urinary cytokines in patients with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). To identify differences in these measures in IC/BPS patients with Hunner’s lesions (IC/BPS-HL) and without Hunner’s lesions (IC/BPS-NHL).MethodsBladder tissue biopsies were obtained from 48 patients with IC/BPS-HL and unaffected controls (UC) and stained with antibodies for various immune cell markers such as CD138, CD20 and CD56. Levels of cytokines (Interferon (IFN)-γ, Interleukin (IL)-1β, IL-2, IL- 4, IL-6, IL-8, IL12P70, IL-13, and TNF-α) were measured from normalized urine obtained from 18 IC/BPS-HL, 18 IC/BPS-NHL, and 4 UC.ResultsNumbers of CD138+ plasma cells, CD20+ B cells, and CD3+ T cells were significantly increased (50 fold, 30 fold, and an almost 3 fold increase, respectively; p-values: 1.34E-06, 3.26E-04, and 2.52E-6) in the bladders of IC/BPS-HL patients compared to UC. Patients with IC/BPS-HL had significantly elevated urinary levels of IL-6 (p=0.0028) and TNF-α (p=0.009) compared to patients with IC/BPS-NHL and UC. In contrast, IL-12p70 levels were significantly higher in the patients with IC/BPS-NHL than in HL patients (p=0.033). No significant difference in IL-12p70 levels were observed between IC/BPS-HL and UC.ConclusionDifferent cytokines were elevated in the urine of IC/BPS patients with and without HL, suggesting differences in underlying disease processes. Elevated levels of CD138+, CD20+, and CD3+ cells in HL indicate B and T-cell involvement in lesion formation. Determining which cytokines and immunological pathways are present in IC/BPS-HL could elucidate the disease mechanism.

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Microbiota of Chronic Prostatitis/Chronic Pelvic Pain Syndrome are Distinct from Interstitial Cystitis/Bladder Pain Syndrome

10.1101/2021.03.04.21252926 ◽

2021 ◽

Author(s):

Bryan White ◽

Michael Welge ◽

Loretta Auvil ◽

Matthew Berry ◽

Colleen Bushell ◽

...

Keyword(s):

Interstitial Cystitis ◽

Pelvic Pain ◽

Chronic Prostatitis ◽

Chronic Pelvic Pain ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Unknown Etiology ◽

Pelvic Pain Syndrome ◽

Bladder Pain

Urologic chronic pelvic pain syndrome patients include men chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and patients, mainly women, with interstitial cystitis/bladder pain syndrome (IC/BPS or IC). CP/CPPS is marked by severe chronic pelvic pain of unknown etiology that is differentially associated with prostatic inflammation. Microbes are known to modulate sensory responses, and microbiota are increasingly understood to drive normal biological processes and pathogenesis, including inflammation. Recent studies have linked fecal dysbiosis with chronic pelvic pain in IC/BPS, suggesting a role for microbiota in modulating UCPPS pain. Similarly, dysbiosis has been reported in CP/CPPS patients, but the relationship between with the dysbiosis of IC/BPS patients is unclear. Here, we characterized the fecal microbiota of men with CP/CPPS and women and men with IC/BPS. Similar to recent reports, we identified fecal dysbiosis in men with CP/CPPS relative to healthy controls among specific phyla and overall differences in diversity and richness. Interestingly, we also observed differences between CP/CPPS microbiota and IC/BPS microbiota that were not likely due to sex differences. These findings suggest that CP/CPPS is marked by changes in the gut microbiome, but these changes differ from IC/BPS. Taken together, UCPPS appears associated with distinct dybioses among CP/CPPS and IC/BPS, raising the possibility of distinct contributions to underlying pelvic pain mechanisms and/or etiologies.

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Bladder pain syndrome

10.1093/med/9780199659579.003.0011 ◽

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.

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Autonomic neurophysiologic implications of disorders comorbid with bladder pain syndrome vs myofascial pelvic pain

Neurourology and Urodynamics ◽

10.1002/nau.23995 ◽

2019 ◽

Vol 38 (5) ◽

pp. 1370-1377 ◽

Cited By ~ 1

Author(s):

Gisela G. Chelimsky ◽

Sheng Yang ◽

Tatiana Sanses ◽

Curtis Tatsuoka ◽

C. A. Tony Buffington ◽

...

Keyword(s):

Pelvic Pain ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Bladder Pain

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Interstitial Cystitis/Bladder Pain Syndrome

Seminars in Reproductive Medicine ◽

10.1055/s-0038-1676089 ◽

2018 ◽

Vol 36 (02) ◽

pp. 123-135 ◽

Cited By ~ 2

Author(s):

Ioana Marcu ◽

E. Campian ◽

Frank Tu

Keyword(s):

Interstitial Cystitis ◽

Pelvic Pain ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Bladder Pain ◽

Painful Bladder ◽

Bladder Symptoms ◽

The Many ◽

American Urological Association ◽

Underlying Pathophysiology

AbstractInterstitial cystitis/bladder pain syndrome is an uncommon but potentially devastating pelvic pain disorder affecting both women and men. This condition is often confusable and comorbid with other pelvic pain disorders. Although our understanding of the underlying pathophysiology is growing, the exact longitudinal course by which peripheral and central aberrations involving the bladder mucosa, peripheral inflammation, and central dysregulation of bladder sensitivity create painful bladder symptoms remains an area in need of further study. Only a limited number of drugs have been approved for treatment by the Food and Drug Administration, and overall durable efficacy of the many treatments reviewed in recent American Urological Association guidelines remains suboptimal, making awareness, early diagnosis, and use of effective treatments early in the disease course, where neural changes may still be reversible, imperative.

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Does cystoscopy method affect the investigation of bladder pain syndrome/interstitial cystitis?

International Urogynecology Journal ◽

10.1007/s00192-020-04512-0 ◽

2020 ◽

Author(s):

Visha K. Tailor ◽

Ellen Morris ◽

Alka A. Bhide ◽

Ruwan Fernando ◽

Guiseppe A. Digesu ◽

...

Keyword(s):

Mast Cell ◽

Cell Count ◽

Interstitial Cystitis ◽

Muscularis Propria ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Detrusor Muscle ◽

Bladder Pain ◽

Significant Difference ◽

Mast Cell Count

Abstract Introduction and hypothesis Cystoscopic investigation to identify associated histological findings of increased mast cells in the detrusor muscle has been recommended by the European Society for the Study of Bladder Pain Syndrome (ESSIC) in the investigation of bladder pain syndrome/interstitial cystitis (BPS/IC). The aim of this study was to identify if the cystoscopy approach impacts the biopsy results when investigating women presenting with symptoms of BPS/IC. Methods We performed a single-centre retrospective analysis of 300 bladder biopsy reports from 2015 to 2018 from women undergoing cystoscopy for BPS/IC. Biopsies obtained using closed cup forceps through a flexible (FC) or rigid cystoscope (RC) were compared. Results Fifty-eight FC biopsies were compared with 242 RC biopsies. FC biopsies had a smaller mean diameter (1.6 mm vs 2.9 mm p < 0.01) and volume (4.1 mm3 vs 9.6 mm3p < 0.001) compared with RC biopsies. There was no significant difference in the histological depth of sampling to the muscularis propria. A total of 292 samples had CD117 immunohistochemical staining for mast cell count (MCC) analysis. The MCC/mm2 was significantly lower in FC biopsies (p < 0.01). Sixteen percent of FC samples compared with 60% of RC samples had a high MCC >28/mm2 (p < 0.01). There was no significant difference in positive microbiology culture between FC (21%) and RC (28%) sampling. Conclusion Rigid and flexible cystoscopy can be used to investigate BPS/IC as recommended by international societies. However, the biopsy method impacts the mast cell count analysis, which can influence diagnosis and management. Therefore, RC would be the optimal investigation.

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Chronic pelvic pain in benign and functional urological conditions: A review and comparison of the UK and European guidelines

Journal of Clinical Urology ◽

10.1177/2051415816686790 ◽

2018 ◽

Vol 11 (2) ◽

pp. 115-121 ◽

Cited By ~ 1

Author(s):

Sophia Cashman ◽

Suzanne Biers

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Current Evidence ◽

Pelvic Pain Syndrome ◽

Bladder Pain ◽

European Guidelines ◽

Relative Paucity

We aim to provide a general overview of the available UK and European guidelines on non-oncological causes of chronic pelvic pain, and highlight any differences in practice. We have reviewed the current guidelines on chronic pelvic pain syndrome (defined as chronic pelvic pain with no identified underlying cause and/or the pain is non-specific or involves more than one organ) and other specific organ pain syndromes particularly relevant to urological clinical practice, including prostate pain syndrome, bladder pain syndrome and gynaecological causes of chronic pelvic pain. We have identified a relative paucity of UK guidelines, and accept that the European Association of Urology provides a comprehensive and current evidence based reference and guide which is utilised and regarded by most urologists as the ‘gold standard’ in UK practice.

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