Pathophysiology, assessment, and treatment of overactive bladder symptoms in patients with interstitial cystitis/bladder pain syndrome

Abstract

Introduction Interstitial cystitis/bladder pain syndrome (IC/BPS) is prevalent, difficult to treat, and has close symptom overlap with overactive bladder (OAB). A review of the pathophysiology, assessment, and treatment of IC/BPS patients with overlapping OAB symptoms has not been summarized recently in the published literature. Methods A review of the published literature on the overlap of IC/BPS and OAB was conducted using MeSH terminology (1992–2022). Results The pathophysiology of IC/BPS is not fully understood. Animal research has found the bladder trigone and base are richly populated by afferent fibers, including many small unmyelinated C‐fibers that may be upregulated in IC/BPS. Successful therapies with multimodal effects on OAB symptoms in patients with IC/BPS are likely to exert beneficial effects on both pain and lower urinary tract symptoms. Potentially efficacious therapies for the treatment of OAB in IC/BPS include pelvic floor physical therapy, oral pharmacotherapy (antimuscarinics and beta‐3 agonists), sacral neuromodulation, percutaneous tibial nerve stimulation, and botulinum toxin A (BTA). Antimuscarinics and beta‐3 agonists have yielded partial efficacy in IC/BPS, although may help differentiate symptoms of OAB from those associated with IC/BPS. The transvaginal trigone treatment (T3) intradetrusor injection approach allows for delivery of therapeutics to the bladder without the need for a cystoscope and appears to be feasible. Conclusions Further research is needed to understand the pathophysiology of IC/BPS and symptom overlap with OAB, which in turn should enable the development of more personalized therapeutics.

Prevalence, Risk Factors, and Psychological Effects of Overactive Bladder in Chinese University Students

“…Unfortunately, this was not considered in our survey due to the difficulty of confirming acute cystitis in this large investigation. Consequently, we excluded individuals with acute UTI, some of whom may have had acute cystitis [ 24 ]. The association of cystitis with OAB should be investigated in the future.…”

Superior Hypogastric Plexus Pulsed Radiofrequency Combined With Posterior Tibialis Nerve Transcutaneous Radiofrequency As A Treatment Option Of Chronic Pelvic Pain Management In Interstitial Cystitis

“…It is characterized by symptoms such as sudden urgency, frequent urination, nocturia, urinary incontinence, pain in the bladder or pelvic region, dyspareunia, and a sense of pressure, which are accompanied by the exclusion of infection and other identi able pathologies. The exact pathophysiology of IC/PBS is not fully understood, but various mechanisms have been proposed, including chronic in ammation, autoimmune dysregulation, bacterial cystitis, urothelial dysfunction, de ciency of glycosaminoglycan barrier, and urinary cytotoxicity [2]. The most common pathological ndings include urothelial denudation and bladder in ammation.…”

Efficacy of the combination of transcutaneous tibial nerve stimulation(TTNS) and mirabegron in women with overactive bladder: a prospective randomized controlled trial

“…The problem becomes increasingly prevalent and severe with age, rising to 15% among those over 40 and 20-30% among women over 65 [3][4]. The pathogenesis of OAB is complex, including neurological diseases, increased detrusor excitability, urothelial dysfunction, and unstable urethral sphincter function [5]. Detrusor overactivity can be detected in some OAB patients by urodynamic examination.…”