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.

Interstitial Cystitis/Bladder Pain Syndrome

2018 ◽  
Vol 36 (02) ◽  
pp. 123-135 ◽  
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.

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.

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 Evidence for Bladder Urothelial Pathophysiology in Functional Bladder Disorders

2014 ◽  
Vol 2014 ◽  
pp. 1-15 ◽  
Author(s):  
Susan K. Keay ◽  
Lori A. Birder ◽  
Toby C. Chai
Keyword(s):  
Urinary Tract ◽  
Interstitial Cystitis ◽  
Pain Syndrome ◽  
Upper Urinary Tract ◽  
Bladder Pain Syndrome ◽  
Bladder Function ◽  
Voiding Function ◽  
Bladder Pain ◽  
Urinary Tract Symptoms ◽  
Bladder Disorders

Understanding of the role of urothelium in regulating bladder function is continuing to evolve. While the urothelium is thought to function primarily as a barrier for preventing injurious substances and microorganisms from gaining access to bladder stroma and upper urinary tract, studies indicate it may also function in cell signaling events relating to voiding function. This review highlights urothelial abnormalities in bladder pain syndrome/interstitial cystitis (BPS/IC), feline interstitial cystitis (FIC), and nonneurogenic idiopathic overactive bladder (OAB). These bladder conditions are typified by lower urinary tract symptoms including urinary frequency, urgency, urgency incontinence, nocturia, and bladder discomfort or pain. Urothelial tissues and cells from affected clinical subjects and asymptomatic controls have been compared for expression of proteins and mRNA. Animal models have also been used to probe urothelial responses to injuries of the urothelium, urethra, or central nervous system, and transgenic techniques are being used to test specific urothelial abnormalities on bladder function. BPS/IC, FIC, and OAB appear to share some common pathophysiology including increased purinergic, TRPV1, and muscarinic signaling, increased urothelial permeability, and aberrant urothelial differentiation. One challenge is to determine which of several abnormally regulated signaling pathways is most important for mediating bladder dysfunction in these syndromes, with a goal of treating these conditions by targeting specific pathophysiology.

scholarly journals Urinary Biomarkers in Interstitial Cystitis/Bladder Pain Syndrome and Its Impact on Therapeutic Outcome

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 75
Author(s):  
Hung-Yu Lin ◽  
Jian-He Lu ◽  
Shu-Mien Chuang ◽  
Kuang-Shun Chueh ◽  
Tai-Jui Juan ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Interstitial Cystitis ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Therapeutic Outcome ◽  
Urinary Biomarkers ◽  
Unknown Etiology ◽  
Bladder Pain ◽  
Urinary Tract Symptoms ◽  
Urgency Symptoms

Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as a chronic bladder disorder with suprapubic pain (pelvic pain) and pressure and/or discomfort related to bladder filling accompanied by lower urinary tract symptoms, such as urinary frequency and urgency without urinary tract infection (UTI) lasting for at least 6 weeks. IC/BPS presents significant bladder pain and frequency urgency symptoms with unknown etiology, and it is without a widely accepted standard in diagnosis. Patients’ pathological features through cystoscopy and histologic features of bladder biopsy determine the presence or absence of Hunner lesions. IC/PBS is categorized into Hunner (ulcerative) type IC/BPS (HIC/BPS) or non-Hunner (nonulcerative) type IC/BPS (NHIC/BPS). The pathophysiology of IC/BPS is composed of multiple possible factors, such as chronic inflammation, autoimmune disorders, neurogenic hyperactivity, urothelial defects, abnormal angiogenesis, oxidative stress, and exogenous urine substances, which play a crucial role in the pathophysiology of IC/BPS. Abnormal expressions of several urine and serum specimens, including growth factor, methylhistamine, glycoprotein, chemokine and cytokines, might be useful as biomarkers for IC/BPS diagnosis. Further studies to identify the key molecules in IC/BPS will help to improve the efficacy of treatment and identify biomarkers of the disease. In this review, we discuss the potential medical therapy and assessment of therapeutic outcome with urinary biomarkers for 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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