Interstitial Cystitis/Bladder Pain Syndrome: Matching Therapies to the Patient

Purpose of ReviewWe intend to establish broad clinical subgroups of patients and match them to a more tailored approach with improved clinical outcomes.Recent FindingsPatient experience over the past four decades and investigative initiatives such as The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) have led to the development of four broad categories of IC/BPS patients: bladder-centric (which is further sub-divided into those with Hunner lesion disease (HLD) and those without (IC/BPS)); widespread/centralized pain; and myofascial pelvic floor tenderness. Other systems of patient categorization, such as UPOINT, now INPUT, highlight the complexities of patient assessment.Reanalysis of previous failed clinical trials and common sense suggests that matching the therapy's mechanism of action to the patient's phenotype may yield better therapeutic outcomes.Recent FindingsPatient experience over the past four decades and investigative initiatives such as The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) have led to the development of four broad categories of IC/BPS patients: bladder-centric (which is further sub-divided into those with Hunner lesion disease (HLD) and those without (IC/BPS)); widespread/centralized pain; and myofascial pelvic floor tenderness. Other systems of patient categorization, such as UPOINT, now INPUT, highlight the complexities of patient assessment.Reanalysis of previous failed clinical trials and common sense suggests that matching the therapy's mechanism of action to the patient's phenotype may yield better therapeutic outcomes.SummaryAlthough the IC/BPS population is known to be phenotypically heterogeneous, therapeutic approaches afforded by most current guidelines have been relatively rigid, only accounting for those patients with and without Hunner lesions. Segregating the IC/BPS population further into distinct phenotypic groups that may respond to targeted therapy is relatively simplistic but represents an essential first step toward precision care.