Histopathological characteristics of interstitial cystitis/bladder pain syndrome without Hunner lesion

Kim, Aram; Han, Ju-Young; Ryu, Chae‐Min; Yu, Hwan Yeul; Lee, Seungun; Kim, YongHwan; Jeong, Soon Young; Cho, Yong Mee; Shin, Dong‐Myung; Choo, Myung‐Soo

doi:10.1111/his.13235

Cited by 63 publications

(63 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Secondly, we can consider the fact that recurrence involved a de novo site in 78.2% of cases. Previous histopathological assessment of Hunner‐type IC showed denudation of the urothelium in both HLs and non‐HLs of the bladder mucosa, suggesting the concept of “pancystitis.” Although HLs may represent the most severely damaged part of urothelium, the residual bladder wall (with the gross appearance of normal mucosa) may show microscopic evidence of an inflammatory response. This could possibly explain the current study finding that the baseline PUF bother score and ICI total score were the only independent predictive factors for HLs recurrence and early recurrence, respectively.…”

Section: Discussionmentioning

confidence: 99%

Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Han

Shin

Choo

2019

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Aims To evaluate the patterns and predictive factors associated with Hunner lesions (HLs) recurrence in patients with interstitial cystitis (IC). Methods This study was a retrospective analysis of data from patients with IC who underwent transurethral resection and cauterization (TUR‐C) of HLs between October 2011 and December 2017. Symptoms were evaluated using the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF), O'Leary‐Sant Interstitial Cystitis Symptom Index, and Visual Analogue Scale (VAS). Patients attended follow‐up visits every 3 months; cystoscopy was performed immediately in patients with aggravated symptoms. Recurrence was defined as a VAS score greater than or equal to 4 and HLs recurrence on cystoscopy. Results A total of 91 patients were enrolled (25 male, 66 female): median follow‐up was 30.6 months. HLs recurrence occurred in 101 sites (53 patients), 21.8% in the previous TUR‐C site, 18.8% de novo, and 59.4% at both previous and de novo sites. The recurrence rate was approximately 12.7%, 40%, and 55.2% at 6, 12, and 18 months, respectively. A higher PUF bother score was the only predictive factor of recurrence (odds ratio: 1.142, 95% confidence interval: 1.016‐1.284, P = 0.026), with a cut‐off value of 7.5 (sensitivity: 67.9%, specificity: 62.5%). In case of late recurrence (>18 months), there was no predictive factor. Conclusions The HLs recurrence pattern was unpredictable, involving both previous TUR‐C and de novo areas. More accurately defining the HLs resection margin may lead to better surgical outcomes but this remains to be proven.

show abstract

Section: Discussionmentioning

confidence: 99%

Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Han

Shin

Choo

2019

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Nonetheless, ablation itself did not reduce the recurrence of HLs, and 64.8% of the patients had new HLs at remote sites other than the previous ablation site. Histopathologically, HL type IC has been reported to be characterised by pancystitis . Inflammatory cell infiltration such as an increase in plasma cells, urothelial denudation and expansion of clonal B‐cells was observed in non‐HL from random biopsy as well as in HL.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic effects of endoscopic ablation in patients with Hunner type interstitial cystitis

Chung

Suh

et al. 2018

BJU International

View full text Add to dashboard Cite

show abstract

“…Kim et al. reported that fibrosis and MC counts are increased in IC/BPS without Hunner lesions, suggesting the potential involvement of neurogenic inflammation in its pathophysiology 106 . Elevated gene expression of NGF and transient receptor potential vanilloid type 2 in IC/BPS without Hunner lesions was also reported 23 .…”

Section: Pathophysiology Of Ic/bpsmentioning

confidence: 96%

Interstitial cystitis/bladder pain syndrome: The evolving landscape, animal models and future perspectives

et al. 2020

View full text Add to dashboard Cite

Abbreviations & Acronyms BPS = bladder pain syndrome CCL2 = C-C motif ligand 2 CNS = central nervous system DMSO = dimethyl sulfoxide EAC = experimental autoimmune cystitis ESSIC = International Society for the Study of BPS FSS = functional somatic syndrome GAG = glycosaminoglycan IC = interstitial cystitis IFN-c = interferon-gamma IL = interleukin MC = mast cell NGF = nerve growth factor OVA = ovalbumin TCR = T-cell receptor TNF = tumor necrosis factor TLR = Toll-like receptor UCPPS = urological chronic pelvic pain syndrome UPK = uroplakin Upo = unpublished observation VEGF = vascular endothelial growth factor WAS = water avoidance stress Correspondence: Yoshiyuki Abstract: Interstitial cystitis/bladder pain syndrome is a debilitating condition of unknown etiology characterized by persistent pelvic pain with lower urinary tract symptoms and comprises a wide variety of potentially clinically useful phenotypes with different possible etiologies. Current clinicopathological and genomic evidence suggests that interstitial cystitis/bladder pain syndrome should be categorized by the presence or absence of Hunner lesions, rather than by clinical phenotyping based on symptomatology. The Hunner lesion subtype is a distinct inflammatory disease with proven bladder etiology characterized by epithelial denudation and enhanced immune responses frequently accompanied by clonal expansion of infiltrating B cells, with potential engagement of infection. Meanwhile, the non-Hunner lesion subtype is a noninflammatory disorder with little evidence of bladder etiology. It is potentially associated with urothelial malfunction and neurophysiological dysfunction, and frequently presents with somatic and/or psychological symptoms, that commonly result in central nervous sensitization. Animal models of autoimmune cystitis and neurogenic sensitization might serve as disease models for the Hunner lesion and non-Hunner lesion subtypes, respectively. Here, we revisit the taxonomy of interstitial cystitis/bladder pain syndrome according to current research, and discuss its potential pathophysiology and representative animal models. Categorization of interstitial cystitis/bladder pain syndrome based on cystoscopy is mandatory to design optimized treatment and research strategies for each subtype. A tailored approach that specifically targets the characteristic inflammation and epithelial denudation for the Hunner lesion subtype, or the urothelial malfunction, sensitized/altered nervous system and psychosocial problems for the non-Hunner lesion subtype, is essential for better clinical management and research progress in this complex condition.

show abstract

Histopathological characteristics of interstitial cystitis/bladder pain syndrome without Hunner lesion

Cited by 63 publications

References 33 publications

Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Therapeutic effects of endoscopic ablation in patients with Hunner type interstitial cystitis

Interstitial cystitis/bladder pain syndrome: The evolving landscape, animal models and future perspectives

Contact Info

Product

Resources

About