Magnus Fall1, Jørgen Nordling2, Mauro Cervigni3, Paulo Dinis Oliveira4, Jennifer Fariello5, Philip Hanno6, Christina Kåbjörn-Gustafsson7, Yr Logadottir8, Jane Meijlink9, Nagendra Mishra10, Robert Moldwin5, Loredana Nasta11, Jorgen Quaghebeur12, Vicki Ratner13, Jukka Sairanen14, Rajesh Taneja15, Hikaru Tomoe16, Tomohiro Ueda17, Gjertrud Wennevik18, Kristene Whitmore19, Jean Jacques Wyndaele20, Andrew Zaitcev21. 1. Department of Urology, Sahlgrenska Academy at the University Gothenburg, Institute of Clinical Sciences, Göteborg, Sweden. 2. Department of Urology, Herlev University Hospital, Copenhagen, Denmark. 3. Female Pelvic Medicine & Reconstructive Surgery Center, Catholic University, Rome, Italy. 4. Department of Urology, Hospital de Sao Joao, University of Porto Faculty of Medicine, Porto, Portugal. 5. The Arthur Smith Institute for Urology, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA. 6. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA. 7. Department of Pathology, County Hospital Ryhov, Jönköping, Sweden. 8. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden. 9. International Painful Bladder Foundation, Naarden, The Netherlands. 10. Pramukh Swami Medical College, Shree Krishna Hospital, Karamsad, India. 11. Italian Interstitial Cystitis Association, Rome, Italy. 12. Department of Urology, Small Pelvis Clinic, University Hospital Antwerpen, Antwerp, Belgium. 13. Interstitial Cystitis Association of America, San Jose, CA, USA. 14. Department of Urology, Helsinki University Central Hospital, Helsinki, Finland. 15. Department of Urology and Andrology, Indraprastha Apollo Hospitals, New Delhi, India. 16. Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. 17. Comfortable Urology Network, Ueda Clinic, Kyoto, Japan. 18. Department of Urology, Herlev and Gentofte Hospital, Copenhagen, Denmark. 19. Department of Urology, Drexel University College of Medicine, Philadelphia, PA, USA. 20. Department of Urology, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp, Belgium. 21. Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Abstract
Objectives: There is confusion about the terms of bladder pain syndrome (BPS) and Interstitial Cystitis (IC). The European Society for the Study of IC (ESSIC) classified these according to objective findings [9]. One phenotype, Hunner lesion disease (HLD or ESSIC 3C) differs markedly from other presentations. Therefore, the question was raised as to whether this is a separate condition or BPS subtype. Methods: An evaluation was made to explore if HLD differs from other BPS presentations regarding symptomatology, physical examination findings, laboratory tests, endoscopy, histopathology, natural history, epidemiology, prognosis and treatment outcomes. Results: Cystoscopy is the method of choice to identify Hunner lesions, histopathology the method to confirm it. You cannot distinguish between main forms of BPS by means of symptoms, physical examination or laboratory tests. Epidemiologic data are incomplete. HLD seems relatively uncommon, although more frequent in older patients than non-HLD. No indication has been presented of BPS and HLD as a continuum of conditions, one developing into the other.Conclusions: A paradigm shift in the understanding of BPS/IC is urgent. A highly topical issue is to separate HLD and BPS: treatment results and prognoses differ substantially. Since historically, IC was tantamount to Hunner lesions and interstitial inflammation in the bladder wall, still, a valid definition, the term IC should preferably be reserved for HLD patients. BPS is a symptom syndrome without specific objective findings and should be used for other patients fulfilling the ESSIC definitions.
Objectives: There is confusion about the terms of bladder pain syndrome (BPS) and Interstitial Cystitis (IC). The European Society for the Study of IC (ESSIC) classified these according to objective findings [9]. One phenotype, Hunner lesion disease (HLD or ESSIC 3C) differs markedly from other presentations. Therefore, the question was raised as to whether this is a separate condition or BPS subtype. Methods: An evaluation was made to explore if HLD differs from other BPS presentations regarding symptomatology, physical examination findings, laboratory tests, endoscopy, histopathology, natural history, epidemiology, prognosis and treatment outcomes. Results: Cystoscopy is the method of choice to identify Hunner lesions, histopathology the method to confirm it. You cannot distinguish between main forms of BPS by means of symptoms, physical examination or laboratory tests. Epidemiologic data are incomplete. HLD seems relatively uncommon, although more frequent in older patients than non-HLD. No indication has been presented of BPS and HLD as a continuum of conditions, one developing into the other.Conclusions: A paradigm shift in the understanding of BPS/IC is urgent. A highly topical issue is to separate HLD and BPS: treatment results and prognoses differ substantially. Since historically, IC was tantamount to Hunner lesions and interstitial inflammation in the bladder wall, still, a valid definition, the term IC should preferably be reserved for HLD patients. BPS is a symptom syndrome without specific objective findings and should be used for other patients fulfilling the ESSIC definitions.
Authors: H Henry Lai; Craig Newcomb; Steve Harte; Dina Appleby; A Lenore Ackerman; Jennifer T Anger; J Curtis Nickel; Priyanka Gupta; Larissa V Rodriguez; J Richard Landis; J Quentin Clemens Journal: Neurourol Urodyn Date: 2021-02-19 Impact factor: 2.696