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Pain Bladder/Pelvic Pain and Neurogenic Inflammation

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Handbook of Neurourology

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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. Beside forming a high-resistance barrier to ion, solute and water flux, and pathogens, the urothelium functions as an integral part of a sensory web which receives, amplifies, and transmits information about its external milieu. In functional pain syndromes such as IC/BPS, there is evidence that the urothelium is associated with altered expression of proteins involved in cellular differentiation, barrier function, and bacterial defense mechanisms. An altered vascular supply has also been observed in the ulcerative form of IC/BPS with locations of moderate-to-severe redness, interspersed among a whitish discoloration. 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. There is also evidence supporting a role for chronic stress in the development, maintenance, and even enhancement of IC/BPS. Studies have revealed that mitochondria (and oxidative stress) play a key role in driving abnormal responses to chronic stress that can translate into altered urothelial signaling, which may impact bladder function. Changes in these and other signaling mechanisms associated with lower urinary tract symptoms are discussed as well as new areas for therapeutic interventions.

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  1. Departments of Medicine-Renal Electrolyte Division and Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Lori Ann Birder

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  1. Lori Ann Birder
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  1. Department of Urology Department of Neurourology, China Rehabiliation Research Center China Rehabilitation Science InstituteCapital Medical University, Beijing, China

    Limin Liao

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

    Helmut Madersbacher

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Birder, L.A. (2023). Pain Bladder/Pelvic Pain and Neurogenic Inflammation. In: Liao, L., Madersbacher, H. (eds) Handbook of Neurourology. Springer, Singapore. https://doi.org/10.1007/978-981-99-1659-7_54

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