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

Review

Urogenit Tract Infect 2017;12(1):22-27.

Published online: 19 April 2017

DOI: https://doi.org/10.14777/uti.2017.12.01.22

Is Urethral Pain Syndrome Really Part of Bladder Pain Syndrome?

Sung Tae Cho

Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea

Correspondence to: Sung Tae Cho http://orcid.org/0000-0002-4691-6159 Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: +82-2-829-5198, Fax: +82-2-846-5198 E-mail: cst326@paran.com

Received 24 March 2017 Revised 10 April 2017 Accepted 10 April 2017

Copyright © 2017 Korean Association of Urogenital Tract Infection and Inflammation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Cystitis, interstitial, Urinary bladder, Urethra

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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].

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