Bladder Pain Syndrome Associated with Interstitial Cystitis: Recent Research and Treatment Options

Purpose of ReviewInterstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain syndrome of unknown etiology, the pathophysiology of which has not been fully explored. This article reports recently published research in diagnosis and treatment of IC/BPS.Recent FindingsCurrent research shows that the syndrome is likely heterogeneous, with different pathogeneses, clinical characteristics, cystoscopic findings, and characteristics of urine biomarkers. Chronic bladder inflammation results in deficits in the bladder urothelial barrier in addition to increased apoptosis and impaired regeneration of urothelial cells, causing bladder pain symptoms and urinary frequency and urgency. The initial therapeutic approach is conservative treatment with lifestyle modification, anti-inflammatory drugs, and intravesical glycosaminoglycan replenishment and dimethyl sulfoxide instillation. In patients with non-Hunner's lesion IC/BPS refractory to conventional therapy, intravesical botulinum toxin A injection and sacral neuromodulation may be tried. Experimental therapies are intravesical platelet-rich plasma, low-energy shock wave bladder treatment and bladder instillation of liposomes with or without mixed botulinum toxin A. For IC/BPS patients with Hunner's lesion, electrocauterization or laser ablation is the first-line treatment. Patients with Epstein-Barr virus infection may also benefit from antiviral therapy. For patients with Hunner's IC/BPS and a contracted bladder, partial cystectomy with augmentation enterocystoplasty or total cystectomy with urinary diversion should be the last resort for treatment to address early elimination and bladder pain and to resume normal lower urinary tract function.SummaryIC/BPS remains a mysterious bladder disease with chronic inflammation and urothelial dysfunction and involves functional somatic disorders. Treatment should be multidisciplinary and target at potential pathogenesis of the disease.