Phenotypes of BPS/IC
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BPS/INTERSTITIAL CYSTITIS (D CASTRO-DIAZ AND Y IGAWA, SECTION EDITORS)
Phenotypes of BPS/IC Sachin Malde 1 & Arun Sahai 1
# The Author(s) 2020
Abstract Purpose of Review The aim of this review is to summarise the latest research related to different phenotypes of BPS/IC, addressing the evidence for current well-defined phenotypes as well as identifying novel potential phenotypes and highlighting areas for future study. Recent Findings Two distinct phenotypes of BPS/IC are well-recognised: Hunner’s lesion disease and non-Hunner’s lesion BPS/IC. Recent studies have shown these phenotypes exhibit distinct clinical, pathological and cystoscopic features, and targeted treatment to Hunner’s lesions can prove effective. Recent studies have also identified new potential phenotypes based on biochemical, molecular and histological markers, pathophysiological mechanisms of disease, clinical features, cystoscopic findings, radiological features and urodynamic factors. This evidence has improved our understanding of the underlying mechanism of disease and may enable more personalised and targeted therapy in the future. Summary Novel phenotypes of BPS/IC relate to the presence of certain biomarkers, alterations in the urinary microbiome, the characteristics of pain and presence of co-existing somatic and psychosocial conditions, altered patterns of brain white matter changes and urodynamic features. Further study is required to evaluate whether these potential phenotypes are clinically useful based on their ability to guide treatment selection and predict outcome from therapy, and therefore optimise therapeutic outcomes. Keywords Bladder pain syndrome . Interstitial cystitis . Phenotype . Hunner’s ulcer . Biomarker
Introduction The symptom complex of persistent or recurrent pain, pressure or discomfort perceived in the urinary bladder region, accompanied by at least one other urinary symptom, such as pain worsening with bladder filling and daytime and/or nighttime urinary frequency or urgency, in the absence of other identifiable causes, is now widely defined as bladder pain syndrome/interstitial cystitis (BPS/IC) [1••, 2•]. Although exact definitions and nomenclature vary, these key symptomatic features have been adopted by all international guidelines in This article is part of the Topical Collection on BPS/Interstitial Cystitis * Sachin Malde [email protected] Arun Sahai [email protected] 1
Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
an attempt to standardise diagnosis, treatment and scientific research into this debilitating chronic condition [3]. However, it is recognised that the umbrella term BPS is likely to encompass numerous different underlying subgroups, or phenotypes, each with a different pathophysiological cause, unique clinical features and differing responses to therapy [4]. One such distinct clinical phenotype, the so-called Hunner lesion disease (HLD), has been recognised since the first descriptions of this condition over 100 years ag
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