<p>Clinical Management of Bladder Pain Syndrome/Interstitial Cystitis: A Review on Current Recommendations and Emerging Treatment Options</p>

Abstract

Bladder pain syndrome (BPS) is a chronic condition characterized by pelvic pain or pressure which is perceived to be originating from the bladder, accompanied by one or more urinary symptoms, including frequency, urgency and nocturia. The precise etiology of BPS is not fully understood. Chronic bacterial infection, defective glycosaminoglycan (GAG) layer of the bladder urothelium, inappropriate activation of mast cells in the suburothelial layer of the bladder, autoimmune-mediated mechanisms and autonomic nervous system dysfunction have all been implicated. Treatments targeted at each of these mechanisms have been developed with mixed outcomes. High-quality research into the treatment options is lacking and it is difficult to draw definite conclusions. The treatment approach is multimodal and should be patient specific, targeting the symptoms which they find most bothersome. Conservative treatment, including patient education, behavioural modification, dietary advice, stress relief and physical therapy is an essential initial management strategy for all patients. If no response is observed, oral treatments such as amitriptyline are likely to offer the greatest response. Cystoscopy is essential to phenotype patients, and Hunner lesion directed therapy with fulguration or resection can be performed at the same time. Intravesical instillation of DMSO or lidocaine, detrusor injections of botulinum toxin A and neuromodulation can be used if initial management fails to improve symptoms. Oral cyclosporin can be trialled in those experienced with its use; however, it is associated with significant adverse events and requires intense monitoring. Lastly, radical surgery should be reserved for those with severe, unremitting BPS, in which quality of life is severely affected and not improved by previously mentioned interventions. Future work investigating exact aetiological factors will help target the development of efficacious treatment options, and several promising oral and intravesical treatments are emerging.

Interstitial Cystitis-Critical Assessment of Current Treatment and Opportunities for Nanodelivery

“…Although the exact cause of IC is inadequately perceived, however different hypothesis suggest various causative factors that may include disturbance in the urothelium lining permeability of the bladder due to deficiency of glycosaminoglycan (GAG), immune system actuation, pole cell penetration, neurogenic mechanisms or any infection. 12 Approximately 5-10% of patients will have ulcerations in the bladder, known as Hunner's injuries (HL) 13 related to more extreme indications and diminished bladder limit. Although it is beyond the realm of possibilities to recognize patients with HL on the basis of manifestations alone, utility of cystoscopy shift between rules, sometimes mandatory and sometimes optional.…”

Roles of mesenchymal stem cells and exosomes in interstitial cystitis/bladder pain syndrome

“…It is preferable for patients with refractory BPS who are not sensitive to other oral or intravesical agents. 48 Intravesical dimethylsulfoxide (DMSO) demonstrated high efficacy in symptom improvements and urodynamic and voiding diary changes with minor side effects. 49 In addition, DMSO remains the only approved drug by the Food and Drug Administration (FDA) to treat IC/BPS, and it is hypothesized to inhibit inflammatory mast cells and promote the relaxation of bladder muscles.…”

Extracellular vesicles derived from mesenchymal stem cells alleviate neuroinflammation and mechanical allodynia in interstitial cystitis rats by inhibiting NLRP3 inflammasome activation

“…The precise etiology of IC is still ambiguous, and multiple theories have been suggested, including endothelial permeability, subclinical infection, autoimmunity, neurologic abnormality and genetic susceptibility [ 5 , 6 ]. Owing to the complex pathogenesis, current therapies for IC are not satisfactory and only provide partial relief [ 2 , 7 ], highlighting the urgent need to develop new effective treatment options for IC. Our previous studies have demonstrated that neuroinflammation in the spinal dorsal horn (SDH) contributes to bladder hypersensitivity and plays a pivotal role in the pathogenesis of IC [ 8 – 10 ].…”