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Von der Endorganerkrankung zum klassifizierbaren Blasenschmerzsyndrom

Paradigmenwechsel im Verständnis urologischer Schmerzsyndrome am Beispiel der interstitiellen Zystitis

From end-organ disease to a classifiable bladder pain syndrome

Paradigm shift in the understanding of urological pain syndromes exemplified by the condition currently called interstitial cystitis

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Zusammenfassung

Für die korrekte Interpretation von Krankheitssymptomen und ihre erfolgreiche Therapie ist das Verständnis der pathophysiologischen Mechanismen der vermuteten Erkrankung von zentraler Bedeutung. Sind zugrunde liegende pathologische Prozesse nur wenig bekannt oder entschlüsselt, kann die Erkrankung nicht zuverlässig diagnostiziert und folglich definiert werden. In einem solchen Fall muss die Erkrankung durch ihre klinischen Manifestationen charakterisiert und definiert werden, es resultiert ein „Syndrom“ als Bezeichnung des Patientenzustands. In der Schmerzmedizin wurde dieser „Syndromweg“ erstmals 1994 von der „International Association for the Study of Pain“ (IASP) für die komplexen regionalen Schmerzsyndrome (complex regional pain syndromes, CRPS) beschritten. Der Morbus Sudeck als Bezeichnung für ein CRPS der Extremitäten wurde obsolet.

Abstract

Growing clinical and scientific data imply that the condition currently called interstitial cystitis is not just a mere bladder end-organ disease but that the symptoms perceived to be related to the bladder are rather one aspect of a complex pelvic pain syndrome. The term bladder pain syndrome/interstitial cystitis (BPS/IC) suggested by the European Society for the Study of IC/PBS (ESSIC) for this condition is currently the only one strictly consistent with the taxonomy guidelines of the European Association of Urology and the International Association for the Study of Pain. BPS would be diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder, accompanied by at least one other urinary symptom such as persistent urge to void or urinary frequency. Confusable diseases as the cause of the symptoms must be excluded. Classification of BPS types might be performed according to findings at cystoscopy with hydrodistention and morphologic findings in bladder biopsies. The end-organ condition interstitial cystitis has thus become a chronic pain syndrome with a predominantly neurovisceral pathophysiology. In daily practice, therapeutic approaches aiming at both the peripheral bladder urothelium and central nervous targets should be combined. A multimodal treatment strategy, such as the combination of tricyclic antidepressants with instillation therapy, still appears reasonable and justified.

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Abbreviations

APF:

Antiproliferativer Faktor

BPH:

Benigne Prostatahyperplasie

BPS:

Bladder Pain Syndrome

CPPS:

Chronic Pelvic Pain Syndrome

CRPS:

Complex Regional Pain Syndrome

EAU:

European Association of Urology

ESSIC:

European Society for the Study of IC/PBS

FDA:

Federal Drug Administration

GAG:

Glykosaminoglykan

GIT:

Gastrointestinaltrakt

HPV:

Humanes Papillomavirus

IASP:

International Association for the Study of Pain

IC:

Interstitial Cystitis

ICI:

International Conference on Incontinence

ICICJ:

International Conference on Interstitial Cystitis Japan

ICS:

International Continence Society

MICA:

Multinational Interstitial Cystitis Association

NIDDK:

National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases

NIH:

National Institute of Health

OAB:

Überaktive Blase

PBS:

Painful Bladder Syndrome

WHO:

Weltgesundheitsorganisation

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  1. Schwerpunkt für Neurourologie, Universitätsklinikum Marienhospital Herne, Ruhr-Universität Bochum, Widumerstraße 8, 44627, Herne, Deutschland

    A. van Ophoven

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van Ophoven, A. Von der Endorganerkrankung zum klassifizierbaren Blasenschmerzsyndrom. Urologe 48, 156–162 (2009). https://doi.org/10.1007/s00120-008-1881-4

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