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Classification, Characterization, and Sub-Grouping of Interstitial Cystitis

  • BPS/Interstitial Cystitis (D Castro-Diaz and Y Igawa, Section Editors)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Interstitial cystitis (IC) and IC-related conditions such as painful bladder syndrome (PBS), bladder pain syndrome (BPS), and hypersensitive bladder (HSB) have a similar symptomatic profile but probably different etiologies. A reasonable classification of these diseases/conditions is mandatory for clinical and investigational progress. We reviewed definition of current terminology and recent research evidence regarding IC and related conditions to propose a sensible classification system.

Recent Findings

The condition with Hunner lesions (Hunner type IC: HIC) is obviously distinct from other categories in terms of histopathology, gene expression, and clinical management; HIC is a bladder-centric disease with heavy inflammation, epithelial denudation, and oligoclonal B cell expansion. Presence of glomerulations or mucosal bleeding after distension appears of least clinical significance. Classification should thus clearly differentiate the condition with Hunner lesions from those without Hunner lesions. The term covering patients as a whole should contain IC, since IC is historically a well-known name and used for insurance reimbursement.

Summary

The proposed classification/taxonomy features an umbrella term (IC/BPS) and two sub-groups, HIC (IC/BPS with Hunner lesions) and BPS (IC/BPS without Hunner lesions). IC/BPS is convenient for the initial management of symptomatic patients, and sub-groups can categorize the patients for the specific management. The characteristic symptom profile of bladder pain, urinary urgency, and increased urinary frequency is to be collectively termed as hypersensitive bladder symptoms.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–78.

    Article  Google Scholar 

  2. van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M, Daha LK, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol. 2008;53:60–7.

    Article  Google Scholar 

  3. Hanno PM, Erickson D, Moldwin R, Faraday MM, American UA. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193:1545–53.

    Article  Google Scholar 

  4. Homma Y, Ueda T, Tomoe H, Lin AT, Kuo HC, Lee MH, et al. Clinical guidelines for interstitial cystitis and hypersensitive bladder updated in 2015. Int J Urol. 2016;23:542–9.

    Article  Google Scholar 

  5. Meijlink JM. Patient-centred standardization in interstitial cystitis/bladder pain syndrome-a PLEA. Transl Androl Urol. 2015;4:499–505.

    PubMed  PubMed Central  Google Scholar 

  6. Meijlink JM. Interstitial cystitis and the painful bladder: a brief history of nomenclature, definitions and criteria. Int J Urol. 2014;21(Suppl 1):4–12.

    Article  Google Scholar 

  7. Hanno PM, Landis JR, Matthews-Cook Y, Kusek J, Nyberg L Jr. The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database study. J Urol. 1999;161:553–7.

    Article  CAS  Google Scholar 

  8. Castro-Diaz D, Cardozo L, Chapple CR, Espuna M, Kelleher C, Kirby M, et al. Urgency and pain in patients with overactive bladder and bladder pain syndrome. What are the differences? Int J Clin Pract. 2014;68:356–62.

    Article  CAS  Google Scholar 

  9. Yamada Y, Nomiya A, Niimi A, Igawa Y, Ito T, Tomoe H, et al. A survey on clinical practice of interstitial cystitis in Japan. Transl Androl Urol. 2015;4:486–90.

    PubMed  PubMed Central  Google Scholar 

  10. •• Maeda D, Akiyama Y, Morikawa T, Kunita A, Ota Y, Katoh H, et al. Hunner-type (classic) interstitial cystitis: a distinct inflammatory disorder characterized by pancystitis, with frequent expansion of clonal B-cells and epithelial denudation. PLoS One. 2015;10:e0143316 Quantitative assessment of histological changes of interstitial cystitis with Hunner lesions.

    Article  Google Scholar 

  11. • Akiyama Y, Morikawa T, Maeda D, Shintani Y, Niimi A, Nomiya A, et al. Increased CXCR3 expression of infiltrating plasma cells in Hunner type interstitial cystitis. Sci Rep. 2016;6:28652 Characterization of inflammatory cells infiltrating the bladder of interstitial cystitis with Hunner lesions.

    Article  CAS  Google Scholar 

  12. Logadottir Y, Delbro D, Fall M, Gjertsson I, Jirholt P, Lindholm C, et al. Cytokine expression in patients with bladder pain syndrome/interstitial cystitis ESSIC type 3C. J Urol. 2014;192:1564–8.

    Article  CAS  Google Scholar 

  13. • Offiah I, Didangelos A, Dawes J, Cartwright R, Khullar V, Bradbury EJ, et al. The expression of inflammatory mediators in bladder pain syndrome. Eur Urol. 2016;70:283–90 Overexpression of multiple inflammatory mediators in interstitial cystitis with Hunner lesions.

    Article  CAS  Google Scholar 

  14. Gamper M, Viereck V, Geissbuhler V, Eberhard J, Binder J, Moll C, et al. Gene expression profile of bladder tissue of patients with ulcerative interstitial cystitis. BMC Genomics. 2009;10:199.

    Article  Google Scholar 

  15. • Gamper M, Viereck V, Eberhard J, Binder J, Moll C, Welter J, et al. Local immune response in bladder pain syndrome/interstitial cystitis ESSIC type 3C. Int Urogynecol J. 2013;(24):2049–57 Active immunological responses in the bladder of interstitial cystitis with Hunner lesions.

    Article  Google Scholar 

  16. Tseng LH, Chen I, Wang CN, Lin YH, Lloyd LK, Lee CL. Genome-based expression profiling study of Hunner’s ulcer type interstitial cystitis: an array of 40-gene model. Int Urogynecol J. 2010;21:911–8.

    Article  Google Scholar 

  17. •• Akiyama Y, Maeda D, Katoh H, Morikawa T, Niimi A, Nomiya A, Sato Y, Kawai T, Goto A, Fujimura T, Fukuhara H, Nakagawa T, Igawa Y, Ishikawa S, Fukayama M, Kume H, Homma Y. Molecular taxonomy of interstitial cystitis/bladder pain syndrome based on whole transcriptome profiling by next-generation RNA sequencing of bladder mucosal biopsies. J Urol. 2019;202:290-300. Distinct transcriptome profiling of intersitial cystitis with Hunner lesions.

    Article  Google Scholar 

  18. • Wennevik GE, Meijlink JM, Hanno P, Nordling J. The role of glomerulations in bladder pain syndrome: a review. J Urol. 2016;195:19–25 A review article to evaluate diagnositic value of glomerulations or mucosal bleeding after distension.

    Article  Google Scholar 

  19. Akiyama Y, Homma Y, Maeda D. Pathology and terminology of interstitial cystitis/bladder pain syndrome: a review. Histol Histopathol. 2019;34:25–32.

    PubMed  Google Scholar 

  20. Akiyama Y, Niimi A, Nomiya A, Yamada Y, Nakagawa T, Fujimura T, et al. Extent of Hunner lesions: the relationships with symptom severity and clinical parameters in Hunner type interstitial cystitis patients. Neurourol Urodyn. 2018;37:1441–7.

    Article  Google Scholar 

  21. Chennamsetty A, Khourdaji I, Goike J, Killinger KA, Girdler B, Peters KM. Electrosurgical management of Hunner ulcers in a referral center’s interstitial cystitis population. Urology. 2015;85:74–8.

    Article  Google Scholar 

  22. Cox M, Klutke JJ, Klutke CG. Assessment of patient outcomes following submucosal injection of triamcinolone for treatment of Hunner’s ulcer subtype interstitial cystitis. Can J Urol. 2009;16:4536–40.

    PubMed  Google Scholar 

  23. Ogawa T, Ishizuka O, Ueda T, Tyagi P, Chancellor MB, Yoshimura N. Pharmacological management of interstitial cystitis /bladder pain syndrome and the role cyclosporine and other immunomodulating drugs play. Expert Rev Clin Pharmacol. 2018;11:495–505.

    Article  CAS  Google Scholar 

  24. Van Moh F, Vetter J, Lai HH. Comparison of urologic and non-urologic presentation in interstitial cystitis/bladder pain syndrome patients with and without Hunner lesions. Neurourol Urodyn. 2018;37:2911–8.

    Article  Google Scholar 

  25. Lai HH, Vetter J, Jain S, Gereau RW, Andriole GL. The overlap and distinction of self-reported symptoms between interstitial cystitis/bladder pain syndrome and overactive bladder: a questionnaire based analysis. J Urol. 2014;192:1679–85.

    Article  Google Scholar 

  26. Regauer S, Gamper M, Fehr MK, Viereck V. Sensory hyperinnervation distinguishes bladder pain syndrome/interstitial cystitis from overactive bladder syndrome. J Urol. 2017;197:159–66.

    Article  Google Scholar 

  27. Homma Y, Nomiya A, Tagaya M, Oyama T, Takagaki K, Nishimatsu H, et al. Increased mRNA expression of genes involved in pronociceptive inflammatory reactions in bladder tissue of interstitial cystitis. J Urol. 2013;190:1925–31.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Japanese Red Cross Medical Center, Hiroo 4-1-22, Shibuyaku, Tokyo, 150-8935, Japan

    Yukio Homma

  2. Department of Urology, The University of Tokyo, Hongo 7-3-1, Bunkyoku, Tokyo, 113-8655, Japan

    Yoshiyuki Akiyama & Akira Nomiya

  3. Department of Urology, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjukuku, Tokyo, 162-8655, Japan

    Aya Niimi

  4. Department of Continence Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyoku, Tokyo, 113-8655, Japan

    Yasuhiko Igawa

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  1. Yukio Homma
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Corresponding author

Correspondence to Yukio Homma.

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Conflict of Interest

Yukio Homma has received speaker honorarium from Astellas, Nippon Chemiphar, and Pfizer, outside the submitted work.

Yasuhiko Igawa has received grants from Kissei, Kyorin, RaQualia, Nippon-Shinyaku, Astellas, Lilium Otuka, Takeda, Tsukada Research Medical, Integral, and Medicon, outside the submitted work. Yasuhiko Igawa has received speaker honorarium from Kissei, Kyorin, Nippon-Shinyaku, Astellas, outside the submitted work.

Yoshiyuki Akiyama, Aya Niimi, and Akira Nomiya declare that they have no conflict interests.

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This article is part of the Topical Collection on BPS/Interstitial Cystitis

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Homma, Y., Akiyama, Y., Niimi, A. et al. Classification, Characterization, and Sub-Grouping of Interstitial Cystitis. Curr Bladder Dysfunct Rep 14, 294–300 (2019). https://doi.org/10.1007/s11884-019-00542-7

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  • DOI: https://doi.org/10.1007/s11884-019-00542-7

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