Hunner lesion versus non‐Hunner lesion interstitial cystitis/bladder pain syndrome

Abstract

Background Global consensus on the standardization of terminology for interstitial cystitis/bladder pain syndrome is lacking and is in the formative stages. The Workshop on Hunner lesion versus non‐Hunner lesion at the 2018 International Consultation on Interstitial Cystitis Japan discussed prevalence, performance and outcome of endoscopy, the role of histopathology, and markers. Methods A panel of experts reviewed the literature regarding Hunner lesion vs. non‐Hunner lesion interstitial cystitis/bladder pain syndrome. Results The prevalence of Hunner lesion has been reported to be 5–57%. Older age and smaller anatomic bladder capacity were associated with Hunner lesions. Cystoscopy using local anesthesia is not adequate in diagnosing interstitial cystitis but is needed to rule out confusable diseases. Cystoscopy with hydrodistention and redistention of the bladder is considered standard. A Hunner lesion is visualized as a quite typical inflammatory reaction: a reddened mucosal area with small vessels radiating towards a central scar, splitting at distension, usually associated with a waterfall bleeding pattern. Biopsies from the inflamed area show inflammatory infiltrates, granulation tissue, detrusor mastocytosis, and fibrin deposits. Ablation of Hunner lesions includes transurethral resection of lesions, fulguration, laser ablation, and cortical steroid injections. Mast cell density is a somewhat controversial matter, described differently in different studies: marked increase in Hunner lesion vs. non‐Hunner lesion in the majority of studies, no difference in a few. Nitric oxide appears to be a definitive marker in distinguishing Hunner lesion vs. non‐Hunner lesion disease. Macrophage migration inhibitory factor is elevated in Hunner lesion patients. Increased level of urinary proinflammatory genes expression has also been found in Hunner lesion subjects. Conclusions Hunner lesion patients are clinically and pathologically distinct from non‐Hunner lesion bladder pain syndrome patients.

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

“…1). Past studies have shown that this entity presents with distinct clinicopathological and genomic characteristics compared with other forms of IC/BPS 5–11 . This evidence suggests that IC/BPS with Hunner lesions comprises a potentially distinct disease entity with different etiology in the IC/BPS umbrella.…”

“…The workshop on IC/BPS phenotyping at the 4th International Consultation on Interstitial Cystitis Japan meeting discussed potential categorization of IC/BPS in terms of their clinical characteristics, epidemiology and bladder histology 4,8 . It was unanimously agreed that IC/BPS with Hunner lesions is a proven, clinically relevant subtype that should be regarded as a distinct disease entity.…”

Bladder Pain Syndrome and Interstitial Cystitis Beyond Horizon: Reports from the Global Interstitial Cystitis/Bladder Pain Society (GIBS) Meeting 2019 Mumbai – India

“…More pain with penetration and pain distinctly provoked during palpation of the bladder at the site of the lesion have been described. The diagnosis is made on cystoscopy, and the endoscopic features have been well described before, as are the findings of histopathological investigation (15).…”

The surgical options for Hunner’s lesions: an update

“…Some say the presence of a Hunner's lesion proves the diagnosis of BPS; but the lesions are not present in all patients with BPS. 14 The definition of an ulcer is 'an abnormal discontinuation in an epithelial surface' for example skin, mouth, stomach or bladder. Magnus Fall, Professor of Urology in Gothenburg, Sweden, suggested Hunner's ulcers (now lesions) are not always true ulcers and should therefore be called Hunner's lesions, and Fall also suggested that BPS can be subdivided into either an ulcer or non-ulcer type.…”

“…Magnus Fall, Professor of Urology in Gothenburg, Sweden, suggested Hunner's ulcers (now lesions) are not always true ulcers and should therefore be called Hunner's lesions, and Fall also suggested that BPS can be subdivided into either an ulcer or non-ulcer type. [14][15][16] Hunner's initial symposium was entitled 'A Rare Type of Bladder Ulcer in Women', and the pathology is still often said to be a rare finding. In 1958, Kinder and Smith reviewed all cases seen at St Peter's and St Paul's Hospitals in London over a 10-year period.…”