Journal List > Urogenit Tract Infect > v.12(1) > 1084221

Cho: Is Urethral Pain Syndrome Really Part of Bladder Pain Syndrome?

Abstract

Urethral pain syndrome is a symptom complex that includes dysuria, urinary urgency, frequency, nocturia, and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. Bladder pain syndrome is a clinical diagnosis, based primarily on chronic symptoms of pain from the bladder and/or pelvis associated with urinary urgency or frequency in the absence of identified cause for the symptoms. To date, the term, urethral pain syndrome, remains to be unclear in referring to a distinct subgroup of bladder pain syndrome. However, these two syndromes share many similarities, except the organ of pain. This review is intended to summarize the current state of literature with regard to similar pathophysiology and possible interrelations between urethral pain syndrome and bladder pain syndrome.

REFERENCES

1.Gallagher DJ., Montgomerie JZ., North JD. Acute infections of the urinary tract and the urethral syndrome in general practice. Br Med J. 1965. 1:622–6.
crossref
2.Abrams P., Cardozo L., Fall M., Grifftihs D., Rosier P., Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003. 61:37–49.
crossref
3.Stamm WE., Running K., McKevitt M., Counts GW., Turck M., Holmes KK. Treatment of the acute urethral syndrome. N Engl J Med. 1981. 304:956–8.
crossref
4.Engeler DS., Baranowski AP., Dinis-Oliveira P., Elneil S., Hughes J., Messelink EJ, et al. 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. 2013. 64:431–9.
crossref
5.Kaur H., Arunkalaivanan AS. Urethral pain syndrome and its management. Obstet Gynecol Surv. 2007. 62:348–51. quiz 353-4.
crossref
6.Dreger NM., Degener S., Roth S., Brandt AS., Lazica DA. [Urethral pain syndrome: fact or fiction—an update]. Urologe A. 2015. 54:1248–55. German.
7.Gittes RF., Nakamura RM. Female urethral syndrome. A female prostatitis? West J Med. 1996. 164:435–8.
8.Gurel H., Gurel SA., Atilla MK. Urethral syndrome and associated risk factors related to obstetrics and gynecology. Eur J Obstet Gynecol Reprod Biol. 1999. 83:5–7.
9.Tait J., Peddie BA., Bailey RR., Arnold EP., Russell GL., Bishop VA, et al. Urethral syndrome (abacterial cystitis)—search for a pathogen. Br J Urol. 1985. 57:552–6.
crossref
10.Parsons CL. The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain. BJU Int. 2011. 107:370–5.
crossref
11.Burkhard FC., Blick N., Hochreiter WW., Studer UE. Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help? J Urol. 2004. 172:232–5.
12.Parsons JK., Parsons CL. The historical origins of interstitial cystitis. J Urol. 2004. 171:20–2.
crossref
13.Fall M., Logadottir Y., Peeker R. Interstitial cystitis is bladder pain syndrome with Hunner's lesion. Int J Urol. 2014. 21(Suppl 1):79–82.
crossref
14.Skene AJC. Diseases of the bladder and urethra in women. 2nd ed.New York: William Wood;1887.
15.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.
crossref
16.Gillenwater JY., Wein AJ. Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28-29, 1987. J Urol. 1988. 140:203–6.
crossref
17.Hanno PM. Bladder pain syndrome (Interstitial Cystitis) and related disorders. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. editors.Campbell-Walsh urology. 10th ed.Philadelphia: Saunders;2012. p. 334–70.
crossref
18.Warren JW., Meyer WA., Greenberg P., Horne L., Diggs C., Tracy JK. Using the International Continence Society's definition of painful bladder syndrome. Urology. 2006. 67:1138–42. discussion 1142-3.
crossref
19.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.
crossref
20.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.
crossref
21.Mouracade P., Lang H., Jacqmin D., Saussine C. [Using the intersitital cystitis new diagnostic criteria in daily practice: about 156 patients]. Prog Urol. 2008. 18:674–7. French.
crossref
22.Hanno P., Dmochowski R. Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurourol Urodyn. 2009. 28:274–86.
crossref
23.Hanno PM., Burks DA., Clemens JQ., Dmochowski RR., Erickson D., Fitzgerald MP, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011. 185:2162–70.
crossref
24.Homma Y. Lower urinary tract symptomatology: its definition and confusion. Int J Urol. 2008. 15:35–43.
crossref
25.Nordling J., Fall M., Hanno P. Global concepts of bladder pain syndrome (interstitial cystitis). World J Urol. 2012. 30:457–64.
crossref
26.Homma Y., Ueda T., Tomoe H., Lin AT., Kuo HC., Lee MH, et al. Clinical guidelines for interstitial cystitis and hypersensitive bladder syndrome. Int J Urol. 2009. 16:597–615.
crossref
27.Warren JW., Langenberg P., Greenberg P., Diggs C., Jacobs S., Wesselmann U. Sites of pain from interstitial cystitis/painful bladder syndrome. J Urol. 2008. 180:1373–7.
crossref
28.FitzGerald MP., Brensinger C., Brubaker L., Propert K. ICDB Study Group. What is the pain of interstitial cystitis like? Int Urogynecol J Pelvic Floor Dysfunct. 2006. 17:69–72.
crossref
29.Cho YS. Interstitial Cystitis/Bladder pain syndrome: a urologic mystery. Int Neurourol J. 2016. 20:3–4.
crossref
30.Keay SK., Birder LA., Chai TC. Evidence for bladder urothelial pathophysiology in functional bladder disorders. Biomed Res Int. 2014. 2014:865463.
crossref
31.Parsons CL., Bullen M., Kahn BS., Stanford EJ., Willems JJ. Gynecologic presentation of interstitial cystitis as detected by intravesical potassium sensitivity. Obstet Gynecol. 2001. 98:127–32.
crossref
32.Parsons CL. Interstitial cystitis and lower urinary tract symptoms in males and females-the combined role of potassium and epithelial dysfunction. Rev Urol. 2002. 4(Suppl 1):S49–55.
33.Birder LA., Andersson KE., Kanai AJ., Hanna-Mitchell AT., Fry CH. Urothelial mucosal signaling and the overactive bladder-ICI-RS 2013. Neurourol Urodyn. 2014. 33:597–601.
crossref
34.Birder LA., de Wachter S., Gillespie J., Wyndaele JJ. Urethral sensation: basic mechanisms and clinical expressions. Int J Urol. 2014. 21(Suppl 1):13–6.
crossref
35.McLennan MT., Melick C., Bent AE. Urethral instability: clinical and urodynamic characteristics. Neurourol Urodyn. 2001. 20:653–60.
crossref

Table 1.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) revised the criteria for interstitial cystitis in 1988
To be included as IC, patients must have either glomerulations on cystoscopic examination or a classic Hunner's ulcer, and they must have either pain associated with the bladder or urinary urgency. Examination for glomerulations should occur after distension of the bladder under anesthesia to 80-100 cmH2O for 1-2 min. The bladder may be distended up to two times before evaluation. The glomerulations must be diffuse–present in at least 3 quadrants of the bladder –and there must be at least 10 glomerulations per quadrant. The glomerulations must not be along the path of the cystoscope (to eliminate artifact from contact instrumentation).
The presence of any one of the following will exclude the diagnosis of interstitial cystitis:
1. Bladder capacity of greater than 350 ml on awake cystometry using either a gas or liquid filling medium
2. Absence of an intense urge to void with the bladder filled to 100 ml of gas or 150 ml of water during cystometry, using a fill rate of 30-100 ml/min
3. The demonstration of phasic involuntary bladder contractions on cystometry using the fill rate described above
4. Duration of symptoms less than 9 months
5. Absence of nocturia
6. Symptoms relieved by antimicrobials, urinary antiseptics, anticholinergics, or antispasmodics
7. A frequency of urination while awake of less than eight times per day
8. A diagnosis of bacterial cystitis or prostatitis within a 3-month period
9. Bladder or lower ureteral calculi
10. Active genital herpes
11. Uterine, cervical, vaginal, or urethral cancer
12. Urethral diverticulum
13. Cyclophosphamide or any type of chemical cystitis
14. Tuberculous cystitis
15. Radiation cystitis
16. Benign or malignant bladder tumors
17. Vaginitis
18. Age less than 18 years

Adapted from Bladder pain syndrome (Interstitial Cystitis) and related disorders. In: Campbell-Walsh urology. 10th ed. Philadelphia: Saunders; 2012. p. 334-70 [17].

TOOLS
Similar articles