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Bladder/Pelvic Pain and Neurogenic Inflammation

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Neurourology

Abstract

Bladder and/or pelvic pain is prominent in patients with chronic prostatitis as well as interstitial cystitis/bladder pain syndrome (IC/BPS). The etiology of IC/BPS remains elusive and may involve multiple causes. IC/BPS has often been described as a disease of the urothelium. Ultrastructurally, an altered vascular supply is observed in its ulcerative form with locations of moderate-to-severe redness, interspersed among a whitish discoloration. There is also evidence that the urothelium is associated with altered synthesis of a number of proteins including those involved in cellular differentiation, barrier function and bacterial defense mechanisms. In addition, neurogenic inflammation of the bladder mucosa may be present in a percentage of patients with IC/BPS in addition to those with prostatitis, chronic pelvic pain and spinal cord injury. The urothelium, which lines the inner surface of the renal pelvis, the ureters and the urinary bladder, not only forms a high-resistance barrier to ion, solute and water flux, and pathogens, but also functions as an integral part of a sensory web which receives, amplifies, and transmits information about its external milieu. Urothelial cells have the ability to sense changes in their extracellular environment, and respond to chemical, mechanical and thermal stimuli by releasing various factors such as ATP, nitric oxide and acetylcholine and impart these changes to underlying bladder nerves and the central nervous system. Changes in these signaling mechanisms associated with lower urinary tract symptoms are discussed as well as new areas for therapeutic interventions.

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  1. Department of Medicine and Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Lori Ann Birder

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  1. Department of Urology, China Rehabiliation Research Center Capital Medical University, Beijing, China

    Limin Liao

  2. Department of Urology, University Hospital, Innsbruck, Austria

    Helmut Madersbacher

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Birder, L.A. (2019). Bladder/Pelvic Pain and Neurogenic Inflammation. In: Liao, L., Madersbacher, H. (eds) Neurourology. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7509-0_54

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