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Trigone as a diagnostic and therapeutic target for bladder-centric interstitial cystitis/bladder pain syndrome

  • Clinical Opinion
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Abstract

The pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) may be bladder-centric, with afferent nerve hyperexcitability and/or due to neural central sensitization. In bladder-centric disease, the trigone’s unmyelinated nociceptive C-fibers are thought to be upregulated, suggesting this as a potential target for diagnostic modalities and for treatment with local anesthetics and chemodenervation. We propose that the transvaginal trigone treatment (T3) route of administration of such treatments should be considered in women with IC/BPS, as this approach is easier and less invasive than cystoscopy. For T3, or other bladder-centric treatments to be successful, patient selection should attempt to exclude patients with predominantly neural central sensitization.

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Abbreviations

BTA:

Botulinum toxin A

CPT:

Current perception threshold

IC/BPS:

Interstitial cystitis/bladder pain syndrome

OAB:

Overactive bladder

OR:

Operating room

PVR:

Postvoid residual

RCT:

Randomized controlled trial

SFPN:

Small fiber polyneuropathy

T3:

Transvaginal trigone treatment

UTI:

Urinary tract infection

VVWTT:

Vesico-vaginal wall thickness at the trigone

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Acknowledgements

A. Dobberfuhl’s investigator-initiated research program is supported by: the National Institutes of Health (NIH) Extramural Loan Repayment Program for Clinical Researchers (NIH 1L30DK115056-01); the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Foundation Study of Chemodenervation; the Stanford Women’s Health and Sex Differences in Medicine (WHSDM) Seed Grant for Biological/Medical Research on Sex Differences and/or Women’s Health. We are grateful to Dr. Nicholas Siddle MBChB, MRCOG for his thorough review of and suggestions for this manuscript.

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Authors and Affiliations

  1. Stanford University School of Medicine, Department of Urology, 300 Pasteur Drive, Grant S-287, Stanford, CA, 94305, USA

    Amy D. Dobberfuhl & Stefanie van Uem

  2. Rutgers Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology and Reproductive Sciences, 125 Paterson Street, New Brunswick, NJ, 08901, USA

    Eboo Versi

Authors
  1. Amy D. Dobberfuhl
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  2. Stefanie van Uem
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  3. Eboo Versi
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Correspondence to Amy D. Dobberfuhl.

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Conflicts of interest

A. Dobberfuhl is an investigator for the SUFU Foundation seed grant entitled “Feasibility and efficacy of transvaginal onabotulinumtoxinA chemodenervation of the trigone for the third line treatment of refractory overactive bladder.” S. van Uem declares no conflicts of interest in relation to the content of the manuscript. E. Versi is the inventor of patent USPTO #8,029,496 entitled “Method and device for delivering drug to the trigone of the bladder” and consultant for Hologic Inc.

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Dobberfuhl, A.D., van Uem, S. & Versi, E. Trigone as a diagnostic and therapeutic target for bladder-centric interstitial cystitis/bladder pain syndrome. Int Urogynecol J 32, 3105–3111 (2021). https://doi.org/10.1007/s00192-021-04878-9

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  • DOI: https://doi.org/10.1007/s00192-021-04878-9

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