Supratrigonal cystectomy and augmentation cystoplasty with ileum or ileocecum in the treatment of ulcerative interstitial cystitis/bladder pain syndrome: a 14-year follow-up

Pathophysiology and potential multimodal therapeutic strategies for IC/BPS

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a bladder disorder with no definite aetiology and currently no effective treatment. Its clinical symptoms vary widely, and the bladder condition and extra-bladder dysfunction also show different clinical presentations. This condition is considered to have multiple factors affecting the bladder and clinical symptoms, including urothelial dysfunction, mast cell activation, autoimmune response, neurogenic inflammation, viral or bacterial infection, autonomic nervous dysfunction and central nervous sensitization. Several non-pharmacological, medical, intravesical and novel bladder therapies have been advocated, but the efficacy and durability of these treatments have not been well elucidated. Multimodal therapy has been suggested based on possible pathological mechanisms; however, the most appropriate therapeutic strategy for this disorder has not been well defined. Thus, a rational algorithm for concomitant multimodal therapy for IC/BPS has been proposed.

Poly(L-lactic acid)/gelatin microfiber membrane loaded with mitomycin C promoting bladder defect repair by anti-fibrosis and antibacterial action

When the bladder is affected by factors such as tumors, tuberculosis, or trauma, its normal structure and function can be severely damaged. At this point, bladder replacement or enlargement surgery may become necessary to restore its structure and improve the patient's quality of life. Traditional bladder reconstruction surgery, specifically ileum augmentation cystoplasty, involves a complex surgical process, along with relatively large operative wounds and possible intestinal obstruction complications. There is also an urgent need for suitable bladder replacement materials. Over the past decade, synthetic bladder scaffolds have emerged as alternatives; however, most fail to simultaneously address the issues of postoperative fibrosis and bacterial infection. To overcome these challenges, we developed an electrospun poly(L-lactic acid)/gelatin (PLLA/GEL) microfiber membrane loaded with mitomycin C (MMC). By optimizing the PLLA/GEL ratio (7 : 3), the membrane exhibited both good rigidity and excellent elasticity. The MMC-loaded fibers demonstrated sustained drug release, effectively inhibiting E. coli and S. aureus in vitro. In rat partial cystectomy models, the PLLA/GEL/MMC group showed a reduction in collagen III deposition through inhibition of the TGF-β/Smad2 pathway, as well as enhanced urothelium regeneration and promotion of angiogenesis. Notably, the membrane maintained cell viability for both urothelial cells and smooth muscle cells over 7 days, confirming its biocompatibility. These findings highlight the promising potential of the PLLA/GEL/MMC microfiber membrane not only as a material for bladder tissue engineering but also as a tool for therapeutic intervention that addresses multiple facets of bladder healing and regeneration.

TRPC3 contributes to cyclophosphamide-induced cystitis progression by enhancing bladder fibrosis through activation of the TGF-β/smad pathway

Background

Bladder pain syndrome/Interstitial cystitis (BPS/IC) is a chronic urological disorder affecting 2.7%-6.5% of the population. The condition is characterized by significant bladder-related pain, with approximately 50% of IC/BPS patients exhibiting bladder fibrosis. Transient receptor potential cation channel subfamily C member 3 (TRPC3), a protein linked to fibrosis in heart and kidneys, emerged as a potential therapeutic target for this condition.

Methods

Using a cyclophosphamide-induced cystitis rat model, we employed RNA sequencing for transcriptional profiling, Western blot for protein quantification, and Masson staining for fibrotic assessment. Cellular-specific TRPC3 expression patterns were elucidated through single-cell transcriptomic analysis. TRPC3 inhibition was implemented via intraperitoneal administration of Pyrazole 3. The study assessed mechanical pain sensitivity and bladder function through von Frey testing and cystometry.

Results

Significant findings revealed TRPC3 RNA and protein expression was markedly upregulated in cystitis rats. TRPC3 inhibition substantially improved mechanical pain sensitivity and reduced micturition frequency. TRPC3 is predominantly expressed in fibroblasts and fibrosis-related pathways are upregulated in cystitis rats. The increased fibrosis markers and collagen fiber deposition are both reversed by TRPC3 inhibition. And the TGF-β/Smad signaling pathway was notably activated and subsequently downregulated with TRPC3 inhibition.

Conclusion

TRPC3 activation contributes significantly to bladder fibrosis in IC/BPS. Inhibiting TRPC3 ameliorates symptoms by modulating TGF-β/Smad pathway, suggesting it as a promising therapeutic target for managing this challenging condition with limited current treatment options.

The Efficacy of Micro-Radiofrequency Therapy for Treating Non-Hunner Lesion Interstitial Cystitis/Bladder Pain Syndrome: A Retrospective Cohort Study

INTRODUCTION AND HYPOTHESIS

The objective was to explore the efficacy of micro-radiofrequency (micro-RF) therapy for treating non-Hunner interstitial cystitis (NHIC).

METHODS

Forty female NHIC patients were enrolled in this retrospective study from December 2021 to December 2023, with 20 receiving intravesical micro-RF therapy and 20 undergoing hydrodistension (HD). The primary evaluation index was the treatment success rate using the Global Response Assessment (GRA) scale. Secondary indexes included changes from baseline in the visual analog scale (VAS) for pain, Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale, and urination parameters. Outcomes were analyzed via t or nonparametric tests.

RESULTS

All 40 patients completed the treatment and follow-up; the treatment success rate of the micro-RF group (70%, 14 out of 20) was slightly higher than that of the HD group (50%, 10 out of 20) at 12 weeks post-treatment, with no significant difference (20%, p = 0.197). The VAS, ICSI, ICPI, PUF, day-time frequency, urgency episodes, and nocturia significantly decreased in both groups after treatment (p < 0.05). Further, the median decline ranges of VAS (-4.0 vs -3.0; p = 0.017; 95% CI -1.45, -0.15) and ICPI (-5.0 vs -4.0; p = 0.011; 95% CI -2.02, -0.283) were significantly larger in the micro-RF group. There were no significant differences in ICSI (-6.5 vs -6.0, p = 0.407), PUF (-10.0 vs. -8.0; p = 0.071), and urgency episodes (-5.5 vs -4.5; p = 0.570).

CONCLUSIONS

Our study showed that the short-term overall efficacy of micro-RF therapy was better than hydrodistension, particularly in managing pain, and might be a new alternative treatment option for patients with NHIC.

Definition Change and Update of Clinical Guidelines for Interstitial Cystitis and Bladder Pain Syndrome

The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.

Female pelvic organ-preserving robot-assisted simple cystectomy and intracorporeal ileal neobladder reconstruction on a young woman with Hunner-type interstitial cystitis

Introduction

Cystectomy is the last treatment option for Hunner-type interstitial cystitis. However, consensus regarding optimal patient selection or treatment approaches is lacking.

Case presentation

A 27-year-old woman presented to a regional hospital with bladder pain and frequent urination. Antimicrobial therapy was administered; however, her symptoms persisted and she was finally diagnosed with HIC. Multiple endoscopic fulgurations of Hunner's lesions with bladder hydrodistension or intravesical therapy were performed; however, the symptoms persisted. A urethral catheter was inserted 1 month before she visited our clinic because of a severely contracted bladder. We performed female pelvic organ-preserving robot-assisted simple cystectomy and intracorporeal ileal neobladder reconstruction. The patient's postoperative course was uneventful and her symptoms resolved.

Conclusion

This is the first report of pelvic organ-preserving robot-assisted simple cystectomy and intracorporeal ileal neobladder reconstruction in a young woman with HIC.

Optimal endoscopic treatment and partial cystectomy with or without bladder augmentation for Hunner-type interstitial cystitis

Interstitial cystitis/bladder pain syndrome (IC/BPS) presents a significant challenge for urologists in terms of management, owing to its chronic nature and adverse impact on patient quality of life. Given the potential distinction between two disease entities within IC/BPS, namely Hunner-type IC and BPS without Hunner lesion, there is a need for an optimal therapeutic approach that focuses on the bladder lesions in Hunner-type IC. In cases where Hunner lesions are observed, complete transurethral ablation of these lesions should be prioritized as the initial intervention, as it has demonstrated effectiveness in symptom control. However, recurrence remains a limitation of this intervention. The techniques of resection and coagulation are equally effective in terms of symptom relief and recurrence prevention. Reconstructive surgery becomes necessary in cases of end-stage IC/BPS where various therapeutic approaches have failed. Patient selection is crucial in reconstructive surgery, particularly for patients with clear Hunner lesions and small bladder capacity who have not responded to previous treatments. Furthermore, it is vital to consider the patients' expectations and preferences adequately. Based on a comprehensive review of the literature and our own clinical experiences, subtotal cystectomy followed by bladder augmentation is considered a safe and effective surgical option. This stepwise and tailored therapeutic approach aims to optimize patients' quality of life by specifically targeting Hunner-type IC.

[Interstitial cystitis/bladder pain syndrome (IC/BPS)]

BACKGROUND

In this review, aspects of interstitial cystitis/bladder pain syndrome (IC/BPS) are presented against the background of the German S2k guideline on this disease.

OBJECTIVE

Quite often this disease, characterized by bladder or lower abdominal pain (permanent or intermittent) and pollakisuria without pathogenic bacteria in the urine culture, is diagnosed much too late.

MATERIALS AND METHODS

The debate on disease definition, aspects on pathophysiology and epidemiology are presented. For diagnosis, disease severity must be determined and relevant differential diagnoses like bladder cancer must be excluded. Conservative measures (clothing, food, sexuality, sport, bladder training, sufficient fluid intake, prevention of hypothermia) are effective especially in early stages of the disease. Combination drug therapy with mucosa stabilizing, anti-inflammatory, psychotropic, and pain-reducing drugs should be adjusted individually. Inpatient rehabilitation, hydrodistension, laser- and electrocoagulation, neuromodulation (sacral or pudendal) or hyperbaric oxygen therapy may help after pharmacotherapy failure. Cystectomy and urinary diversion are used in irreversible shrunken urinary bladder.

RESULTS

If all treatment modalities are consequently used, many patients may reach a state that is more bearable.

CONCLUSION

With a high level of suffering in many patients with IC/BPS, all available treatment modalities should be known and used.

Broaden Horizons: The Advancement of Interstitial Cystitis/Bladder Pain Syndrome

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating disease that induces mental stress, lower urinary symptoms, and pelvic pain, therefore resulting in a decline in quality of life. The present diagnoses and treatments still lead to unsatisfactory outcomes, and novel diagnostic and therapeutic modalities are needed. Although our understanding of the etiology and pathophysiology of IC/BPS is growing, the altered permeability of the impaired urothelium, the sensitized nerves on the bladder wall, and the chronic or intermittent sensory pain with inaccurate location, as well as pathologic angiogenesis, fibrosis, and Hunner lesions, all act as barriers to better diagnoses and treatments. This study aimed to summarize the comprehensive information on IC/BPS research, thereby promoting the progress of IC/BPS in the aspects of diagnosis, treatment, and prognosis. According to diverse international guidelines, the etiology of IC/BPS is associated with multiple factors, while the presence of Hunner lesions could largely distinguish the pathology, diagnosis, and treatment of non-Hunner lesions in IC/BPS patients. On the basis of the diagnosis of exclusion, the diverse present diagnostic and therapeutic procedures are undergoing a transition from a single approach to multimodal strategies targeting different potential phenotypes recommended by different guidelines. Investigations into the mechanisms involved in urinary symptoms, pain sensation, and bladder fibrosis indicate the pathophysiology of IC/BPS for further potential strategies, both in diagnosis and treatment. An overview of IC/BPS in terms of epidemiology, etiology, pathology, diagnosis, treatment, and fundamental research is provided with the latest evidence. On the basis of shared decision-making, a multimodal strategy of diagnosis and treatment targeting potential phenotypes for individual patients with IC/BPS would be of great benefit for the entire process of management. The complexity and emerging evidence on IC/BPS elicit more relevant studies and research and could optimize the management of IC/BPS patients.