Neurourology and urodynamics · 2025
How Can We Make Progress in the Management of Bladder Pain Syndrome? ICI-RS 2025.
СтатьяОбзорConsensus StatementНазвание и аннотация: Перевод в очереди
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Malde Sachin, Sinha Sanjay, Dmochowski Roger, Samarinas Michael, Tyagi Pradeep, Carolina Ochoa D, Selai Caroline, Charrua Ana, Wein Alan J, Abrams Paul
Аннотация
AIMS: Management algorithms for Bladder Pain Syndrome (BPS) have remained stagnant over the past 20 years. Lack of high level evidence has hindered progress. Contributors to this have been the use of confusing and inconsistent terminology and failure to adequately phenotype participants entering clinical trials. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2025 a Think Tank addressed the question of "How can we make progress in the management of Bladder Pain Syndrome," focussing on the non-Hunner lesion group.
METHODS: The Think Tank conducted a literature review and expert consensus meeting focusing on the current limitations in terminology and phenotyping, how we can improve identification of bladder-centric BPS, and how we can improve assessment of psychological comorbidity.
RESULTS: Terminology needs to be standardised to enable more homogenous recruitment to clinical trials. Use of the term "interstitial cystitis" may be misleading, and the term is often inappropriately used. Classification based on the European Association of Urology guidelines should be favoured, using the term Primary Bladder Pain Syndrome. Participants entering clinical trials need to undergo thorough investigation to enable accurate phenotyping. The non-Hunner lesion BPS group need to be the focus of future research. Tools to aid identification of a bladder-centric phenotype (through biopsy and other techniques) need to be studied, including investigating the roles of inflammation, ischaemia and oxidative stress in this condition. A psychological assessment tool specific for BPS should be created to ensure earlier psychological intervention for those who would benefit most.
CONCLUSIONS: The use of accurate terminology in describing this condition is the first step toward improving the quality of future research. The Think Tank overwhelmingly recommended that the term "Interstitial Cystitis" should not be used. Future studies should be focussed on understanding the BPS group, excluding those with Hunner lesion disease. Studying inflammation, ischaemia and oxidative stress will help to identify a bladder-centric phenotype, whereas improving our understanding of psychological mechanisms will help to direct psychological therapies more effectively.
METHODS: The Think Tank conducted a literature review and expert consensus meeting focusing on the current limitations in terminology and phenotyping, how we can improve identification of bladder-centric BPS, and how we can improve assessment of psychological comorbidity.
RESULTS: Terminology needs to be standardised to enable more homogenous recruitment to clinical trials. Use of the term "interstitial cystitis" may be misleading, and the term is often inappropriately used. Classification based on the European Association of Urology guidelines should be favoured, using the term Primary Bladder Pain Syndrome. Participants entering clinical trials need to undergo thorough investigation to enable accurate phenotyping. The non-Hunner lesion BPS group need to be the focus of future research. Tools to aid identification of a bladder-centric phenotype (through biopsy and other techniques) need to be studied, including investigating the roles of inflammation, ischaemia and oxidative stress in this condition. A psychological assessment tool specific for BPS should be created to ensure earlier psychological intervention for those who would benefit most.
CONCLUSIONS: The use of accurate terminology in describing this condition is the first step toward improving the quality of future research. The Think Tank overwhelmingly recommended that the term "Interstitial Cystitis" should not be used. Future studies should be focussed on understanding the BPS group, excluding those with Hunner lesion disease. Studying inflammation, ischaemia and oxidative stress will help to identify a bladder-centric phenotype, whereas improving our understanding of psychological mechanisms will help to direct psychological therapies more effectively.