Der Urologe

, Volume 56, Issue 6, pp 811–827 | Cite as

Interstitielle Zystitis

Diagnostik, medikamentöse und operative Therapie
  • A. Gonsior
  • J. Neuhaus
  • L. C. Horn
  • T. Bschleipfer
  • J.-U. Stolzenburg
CME
  • 352 Downloads

Zusammenfassung

Die interstitielle Zystitis/das Blasenschmerzsyndrom (IC/BPS) ist eine chronische Erkrankung mit weitreichenden negativen Auswirkungen auf die Lebensqualität. Eine autoimmungenetische Prädisposition korreliert mit der Theorie der Pathogenese. Die Diagnostik erfordert eine Anamnese, Miktionstagebücher, körperliche und differenzialdiagnostische Untersuchungen, eine Zystoskopie mit oder ohne Hydrodistension und/oder eine Blasenbiopsie. Verschiedene biologische Marker werden getestet, sind aber bisher nicht etabliert. Verhaltensmaßnahmen sowie pharmakologische orale und intravesikale, interventionelle und chirurgische Therapien mit einem breiten Spektrum publizierter Therapieerfolge stehen zur Verfügung. Ein multimodaler Ansatz ist empfehlenswert, den meisten therapeutischen Optionen fehlt es jedoch am „level of evidence“.

Schlüsselwörter

Interstitielle Zystitis Chronischer Beckenschmerz Blasenschmerzsyndrom Diagnostik Therapie 

Interstitial cystitis

Diagnosis and pharmacological and surgical therapy

Abstract

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating condition which generally has a severely negative impact on quality of life. An autoimmune genetic predisposition correlates with the theory of pathogenesis. Diagnosis requires history, diaries, physical examination, exclusion of other diseases, cystoscopy with or without hydrodistension and/or bladder biopsy. Novel biological markers are upcoming but not established. Behavioural, pharmacological oral and intravesical, interventional and surgical therapies with a wide range of reported success are available. A multimodal approach is recommended, although most of the therapeutic options lack a high degree of evidence.

Keywords

Interstitial cystitis Chronic pelvic pain Bladder pain syndrome Diagnostics Therapeutics 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Gonsior ist als Berater für Medtronic, Allergan und Astellas tätig. T. Bschleipfer ist Mitglied des ICA-Verbandes und als Berater für Allergan, Astellas, Bayer Healthcare, bene-Arzneimittel, Bionorica, Dr. R. Pfleger und Pfizer tätig. J. Neuhaus, L.C. Horn und J.-U. Stolzenburg geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Hatchett L, Fitzgerald MP, Potts J et al (2009) Life impact of urologic pain syndromes. J Health Psychol 14(6):741–750CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Jocham D, Froehlich G, Sandig F et al (2013) The care situation of patients with interstitial cystitis in Germany: results of a survey of 270 patients (Die Versorgungssituation von Patienten mit interstitieller Zystitis in Deutschland : Ergebnisse einer Umfrage unter 270 Betroffenen). Urologe A 52(5):691–702CrossRefPubMedGoogle Scholar
  3. 3.
    Hanno PM, Burks DA, Clemens JQ et al (2011) AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol 185(6):2162–2170CrossRefPubMedGoogle Scholar
  4. 4.
    Homma Y, Ueda T, Tomoe H et al (2016) Clinical guidelines for interstitial cystitis and hypersensitive bladder updated in 2015. Int J Urol 23(7):542–549CrossRefPubMedGoogle Scholar
  5. 5.
    Engeler DS, Baranowski AP, Dinis-Oliveira P et al (2013) The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol 64(3):431–439CrossRefPubMedGoogle Scholar
  6. 6.
    Fall M, Baranowski AP, Elneil S et al (2010) EAU guidelines on chronic pelvic pain. Eur Urol 57(1):35–48CrossRefPubMedGoogle Scholar
  7. 7.
    van de Merwe JP, Nordling J, Bouchelouche P et al (2008) Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol 53(1):60–67CrossRefPubMedGoogle Scholar
  8. 8.
    Bschleipfer T, Vahlensieck W, Doggweiler R (2015) Interstitielle Zystitis/Blasenschmerzsyndrom. Urol Scan 02(04):265–278CrossRefGoogle Scholar
  9. 9.
    Parsons CL (2015) How does interstitial cystitis begin? Transl Androl Urol 4(6):605–610PubMedPubMedCentralGoogle Scholar
  10. 10.
    Farmer MA, Chanda ML, Parks EL et al (2011) Brain functional and anatomical changes in chronic prostatitis/chronic pelvic pain syndrome. J Urol 186(1):117–124CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Clemens JQ, Meenan RT, Rosetti MCO et al (2005) Prevalence and incidence of interstitial cystitis in a managed care population. J Urol 173(1):98–102CrossRefPubMedGoogle Scholar
  12. 12.
    Curhan GC, Speizer FE, Hunter DJ et al (1999) Epidemiology of interstitial cystitis: a population based study. J Urol 161(2):549–552CrossRefPubMedGoogle Scholar
  13. 13.
    Kusek JW, Nyberg LM (2001) The epidemiology of interstitial cystitis: is it time to expand our definition? Urology 57(6 Suppl 1):95–99CrossRefPubMedGoogle Scholar
  14. 14.
    Rosenberg MT, Page S, Hazzard MA (2007) Prevalence of interstitial cystitis in a primary care setting. Urology 69(4 Suppl):48–52CrossRefPubMedGoogle Scholar
  15. 15.
    Berry SH, Elliott MN, Suttorp M et al (2011) Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol 186(2):540–544CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hunner GL (1918) A rare type of bladder ulcer: further notes, with a report of eighteen cases. JAMA 17(70):203–212CrossRefGoogle Scholar
  17. 17.
    Kuo HC (2014) Potential urine and serum biomarkers for patients with bladder pain syndrome/interstitial cystitis. Int J Urol 21(Suppl 1):34–41CrossRefPubMedGoogle Scholar
  18. 18.
    Theoharides TC, Alysandratos K‑D, Angelidou A et al (2012) Mast cells and inflammation. Biochim Biophys Acta 1822(1):21–33CrossRefPubMedGoogle Scholar
  19. 19.
    Altman D, Lundholm C, Milsom I et al (2011) The genetic and environmental contribution to the occurrence of bladder pain syndrome: an empirical approach in a nationwide population sample. Eur Urol 59(2):280–285CrossRefPubMedGoogle Scholar
  20. 20.
    Emmungil H, Kalfa M, Zihni FY et al (2012) Interstitial cystitis: a rare manifestation of primary Sjogren’s syndrome, successfully treated with low dose cyclosporine. Rheumatol Int 32(5):1215–1218CrossRefPubMedGoogle Scholar
  21. 21.
    Schwalenberg T, Berger FP, Horn LC et al (2015) Intravesical glycosaminoglycan replacement with chondroitin sulphate (Gepan((R)) instill) in patients with chronic radiotherapy- or chemotherapy-associated cystitis. Clin Drug Investig 35(8):505–512CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Warren JW, Jackson TL, Langenberg P et al (2004) Prevalence of interstitial cystitis in first-degree relatives of patients with interstitial cystitis. Urology 63(1):17–21CrossRefPubMedGoogle Scholar
  23. 23.
    Davis NF, Brady CM, Creagh T (2014) Interstitial cystitis/painful bladder syndrome: epidemiology, pathophysiology and evidence-based treatment options. Eur J Obstet Gynecol Reprod Biol 175:30–37CrossRefPubMedGoogle Scholar
  24. 24.
  25. 25.
    Chambers GK, Fenster HN, Cripps S et al (1999) An assessment of the use of intravesical potassium in the diagnosis of interstitial cystitis. J Urol 162(3 Pt 1):699–701CrossRefPubMedGoogle Scholar
  26. 26.
    Jiang Y‑H, Jhang J‑F, Kuo H‑C (2016) Revisiting the role of potassium sensitivity testing and cystoscopic hydrodistention for the diagnosis of interstitial cystitis. PLOS ONE 11(3):e0151692CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Keay SK, Zhang CO, Shoenfelt J et al (2001) Sensitivity and specificity of antiproliferative factor, heparin-binding epidermal growth factor-like growth factor, and epidermal growth factor as urine markers for interstitial cystitis. Urology 57(6 Suppl 1):9–14CrossRefPubMedGoogle Scholar
  28. 28.
    Baka S, Kouskouni E, Antonopoulou S et al (2009) Prevalence of ureaplasma urealyticum and mycoplasma hominis in women with chronic urinary symptoms. Urology 74(1):62–66CrossRefPubMedGoogle Scholar
  29. 29.
    Kim H‑J (2016) Update on the pathology and diagnosis of interstitial cystitis/bladder pain syndrome: a review. Int Neurourol J 20(1):13–17CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Regauer S (2016) Mast cell activation syndrome in pain syndromes bladder pain syndrome/interstitial cystitis and vulvodynia. Transl Androl Urol 5(3):396–397CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Gamper M, Regauer S, Welter J et al (2015) Are mast cells still good biomarkers for bladder pain syndrome/interstitial cystitis? J Urol 193(6):1994–2000CrossRefPubMedGoogle Scholar
  32. 32.
    Tettamanti G, Nyman-Iliadou A, Pedersen NL et al (2011) Influence of smoking, coffee, and tea consumption on bladder pain syndrome in female twins. Urology 77(6):1313–1317CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Parsons CL, Koprowski PF (1991) Interstitial cystitis: successful management by increasing urinary voiding intervals. Urology 37(3):207–212CrossRefPubMedGoogle Scholar
  34. 34.
    Hill JR, Isom-Batz G, Panagopoulos G et al (2008) Patient perceived outcomes of treatments used for interstitial cystitis. Urology 71(1):62–66CrossRefPubMedGoogle Scholar
  35. 35.
    Nickel JC, Herschorn S, Whitmore KE et al (2015) Pentosan polysulfate sodium for treatment of interstitial cystitis/bladder pain syndrome: insights from a randomized, double-blind, placebo controlled study. J Urol 193(3):857–862CrossRefPubMedGoogle Scholar
  36. 36.
    Nickel JC, Barkin J, Forrest J et al (2005) Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Urology 65(4):654–658CrossRefPubMedGoogle Scholar
  37. 37.
    Cervigni M (2015) Interstitial cystitis/bladder pain syndrome and glycosaminoglycans replacement therapy. Transl Androl Urol 4(6):638–642PubMedPubMedCentralGoogle Scholar
  38. 38.
    Moldwin RM, Evans RJ, Stanford EJ et al (2007) Rational approaches to the treatment of patients with interstitial cystitis. Urology 69(4 Suppl):73–81CrossRefPubMedGoogle Scholar
  39. 39.
    Davis EL, El Khoudary SR, Talbott EO et al (2008) Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol 179(1):177–185CrossRefPubMedGoogle Scholar
  40. 40.
    van Ophoven A, Hertle L (2005) Long-term results of amitriptyline treatment for interstitial cystitis. J Urol 174(5):1837–1840CrossRefPubMedGoogle Scholar
  41. 41.
    Chen H, Wang F, Chen W et al (2014) Efficacy of daily low-dose sildenafil for treating interstitial cystitis: results of a randomized, double-blind, placebo-controlled trial – treatment of interstitial cystitis/painful bladder syndrome with low-dose sildenafil. Urology 84(1):51–56CrossRefPubMedGoogle Scholar
  42. 42.
    Sairanen J, Tammela TLJ, Leppilahti M et al (2005) Cyclosporine A and pentosan polysulfate sodium for the treatment of interstitial cystitis: a randomized comparative study. J Urol 174(6):2235–2238CrossRefPubMedGoogle Scholar
  43. 43.
    Nickel JC, Egerdie RB, Steinhoff G et al (2010) A multicenter, randomized, double-blind, parallel group pilot evaluation of the efficacy and safety of intravesical sodium chondroitin sulfate versus vehicle control in patients with interstitial cystitis/painful bladder syndrome. Urology 76(4):804–809CrossRefPubMedGoogle Scholar
  44. 44.
    Parsons CL, Koziol JA, Proctor JG et al (2015) Heparin and alkalinized lidocaine versus alkalinized lidocaine for treatment of interstitial cystitis symptoms. Can J Urol 22(2):7739–7744PubMedGoogle Scholar
  45. 45.
    Henry RA, Morales A, Cahill CM (2015) Beyond a simple anesthetic effect: Lidocaine in the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Urology 85(5):1025–1033CrossRefPubMedGoogle Scholar
  46. 46.
    Nomiya A, Naruse T, Niimi A et al (2013) On- and post-treatment symptom relief by repeated instillations of heparin and alkalized lidocaine in interstitial cystitis. Int J Urol 20(11):1118–1122CrossRefPubMedGoogle Scholar
  47. 47.
    Downey A (2015) Intravesical chondroitin sulphate for interstitial cystitis/painful bladder syndrome. Ulster Med J 84(3):161–163PubMedPubMedCentralGoogle Scholar
  48. 48.
    Tomoe H (2015) In what type of interstitial cystitis/bladder pain syndrome is DMSO intravesical instillation therapy effective? Transl Androl Urol 4(6):600–604PubMedPubMedCentralGoogle Scholar
  49. 49.
    Cervigni M, Sommariva M, Tenaglia R et al (2016) A randomized, open-label, multicenter study of the efficacy and safety of intravesical hyaluronic acid and chondroitin sulfate versus dimethyl sulfoxide in women with bladder pain syndrome/interstitial cystitis. Neurourol Urodyn. doi: 10.1002/nau.23091 Google Scholar
  50. 50.
    Payne CK, Mosbaugh PG, Forrest JB et al (2005) Intravesical resiniferatoxin for the treatment of interstitial cystitis: a randomized, double-blind, placebo controlled trial. J Urol 173(5):1590–1594CrossRefPubMedGoogle Scholar
  51. 51.
    Neuhaus J, Schwalenberg T (2012) Intravesical treatments of bladder pain syndrome/interstitial cystitis. Nat Rev Urol 9(12):707–720CrossRefPubMedGoogle Scholar
  52. 52.
    van Ophoven A, Rossbach G, Pajonk F et al (2006) Safety and efficacy of hyperbaric oxygen therapy for the treatment of interstitial cystitis: a randomized, sham controlled, double-blind trial. J Urol 176(4 Pt 1):1442–1446CrossRefPubMedGoogle Scholar
  53. 53.
    Lucioni A, Bales GT, Lotan TL et al (2008) Botulinum toxin type A inhibits sensory neuropeptide release in rat bladder models of acute injury and chronic inflammation. BJU Int 101(3):366–370CrossRefPubMedGoogle Scholar
  54. 54.
    Meng J, Wang J, Lawrence G et al (2007) Synaptobrevin I mediates exocytosis of CGRP from sensory neurons and inhibition by botulinum toxins reflects their anti-nociceptive potential. J Cell Sci 120(Pt 16):2864–2874CrossRefPubMedGoogle Scholar
  55. 55.
    Chuang Y‑C, Yoshimura N, Huang C‑C et al (2009) Intravesical botulinum toxin A administration inhibits COX-2 and EP4 expression and suppresses bladder hyperactivity in cyclophosphamide-induced cystitis in rats. Eur Urol 56(1):159–166CrossRefPubMedGoogle Scholar
  56. 56.
    Jhang J‑F, Kuo H‑C (2016) Botulinum toxin A and lower urinary tract dysfunction: pathophysiology and mechanisms of action. Toxins (Basel) 8(4):120CrossRefGoogle Scholar
  57. 57.
    Kuo H‑C, Jiang Y‑H, Tsai Y‑C et al (2016) Intravesical botulinum toxin – A injections reduce bladder pain of interstitial cystitis/bladder pain syndrome refractory to conventional treatment – A prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial. Neurourol Urodyn 35(5):609–614CrossRefPubMedGoogle Scholar
  58. 58.
    Lee C‑L, Kuo H‑C (2013) Intravesical botulinum toxin a injections do not benefit patients with ulcer type interstitial cystitis. Pain Physician 16(2):109–116PubMedGoogle Scholar
  59. 59.
    Steinberg AC, Oyama IA, Whitmore KE (2007) Bilateral S3 stimulator in patients with interstitial cystitis. Urology 69(3):441–443CrossRefPubMedGoogle Scholar
  60. 60.
    Whitmore KE, Payne CK, Diokno AC et al (2003) Sacral neuromodulation in patients with interstitial cystitis: a multicenter clinical trial. Int Urogynecol J Pelvic Floor Dysfunct 14(5):305–309CrossRefPubMedGoogle Scholar
  61. 61.
    Marinkovic SP, Gillen LM, Marinkovic CM (2011) Minimum 6‑year outcomes for interstitial cystitis treated with sacral neuromodulation. Int Urogynecol J 22(4):407–412CrossRefPubMedGoogle Scholar
  62. 62.
    Powell CR, Kreder KJ (2010) Long-term outcomes of urgency-frequency syndrome due to painful bladder syndrome treated with sacral neuromodulation and analysis of failures. J Urol 183(1):173–176CrossRefPubMedGoogle Scholar
  63. 63.
    Payne RA, O’Connor RC, Kressin M et al (2009) Endoscopic ablation of Hunner’s lesions in interstitial cystitis patients. Can Urol Assoc J 3(6):473–477CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Linn J, Hohenfellner M, Roth S et al (1998) Treatment of interstitial cystitis. Comparison of subtrigonal and supratrigonal cystectomy combined with orthotopic bladder substitution. J Urol 159(3):774–778CrossRefPubMedGoogle Scholar
  65. 65.
    Peeker R, Aldenborg F, Fall M (1998) The treatment of interstitial cystitis with supratrigonal cystectomy and ileocystoplasty: difference in outcome between classic and nonulcer disease. J Urol 159(5):1479–1482CrossRefPubMedGoogle Scholar
  66. 66.
    Yang T‑X, Luo D‑Y, Li H et al (2016) Is urethrectomy necessary during cystectomy in patients with interstitial cystitis or bladder pain syndrome? Urology. doi: 10.1016/j.urology.2016.07.003 Google Scholar
  67. 67.
    van Ophoven A, Oberpenning F, Hertle L (2002) Long-term results of trigone-preserving orthotopic substitution enterocystoplasty for interstitial cystitis. J Urol 167(2 Pt 1):603–607CrossRefPubMedGoogle Scholar
  68. 68.
    Kochakarn W, Lertsithichai P, Pummangura W (2007) Bladder substitution by ileal neobladder for women with interstitial cystitis. Int Braz J Urol 33(4):486–492CrossRefPubMedGoogle Scholar
  69. 69.
    Kim HJ, Lee JS, Cho WJ et al (2014) Efficacy and safety of augmentation ileocystoplasty combined with supratrigonal cystectomy for the treatment of refractory bladder pain syndrome/interstitial cystitis with Hunner’s lesion. Int J Urol 21(Suppl 1):69–73CrossRefPubMedGoogle Scholar
  70. 70.
    Braundmeier-Fleming A, Russell NT, Yang W et al (2016) Stool-based biomarkers of interstitial cystitis/bladder pain syndrome. Sci Rep 6:26083CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Peters KM, Hasenau D, Killinger KA et al (2014) Liposomal bladder instillations for IC/BPS: an open-label clinical evaluation. Int Urol Nephrol 46(12):2291–2295CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Kim A, Shin D‑M, Choo M‑S (2016) Stem cell therapy for interstitial cystitis/bladder pain syndrome. Curr Urol Rep 17(1):1CrossRefPubMedGoogle Scholar
  73. 73.
    Neuhaus J, Schulte-Baukloh H, Stolzenburg J‑U et al (2012) Individual receptor profiling as a novel tool to support diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC). World J Urol 30(5):693–700CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • A. Gonsior
    • 1
  • J. Neuhaus
    • 1
  • L. C. Horn
    • 2
  • T. Bschleipfer
    • 3
  • J.-U. Stolzenburg
    • 1
  1. 1.Klinik für UrologieUniversitätsklinik Leipzig AöRLeipzigDeutschland
  2. 2.Institut für PathologieUniversitätsklinik Leipzig AöRLeipzigDeutschland
  3. 3.Klinik für UrologieKlinikum WeidenWeidenDeutschland

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