Painful bladder syndrome: Pathophysiology and current therapeutic approaches

Abstract

Introduction: Painful bladder syndrome or also called interstitial cystitis (IC/BPS) is a chronic pelvic pain disorder that is perceived as originating in the bladder and is accompanied by one or more symptoms of the lower urinary tract, without other identifiable cause. Objective: Analyze the most current information regarding the pathophysiology and therapeutic approaches of Bladder Pain Syndrome. Methodology: A systematic review of the scientific literature on Bladder Pain Syndrome: Physiopathology and current therapeutic approaches was conducted based on articles obtained from different databases such as: Pubmed, ScienceDirect, Medigraphic, Cochrane, Medline, ElSevier, etc.; publishing during the last five years and that contained up-to-date and relevant information. Results: IC/BPS encompasses several clinical phenotypes with different pathophysiological mechanisms and, therefore, different therapeutic management. Two subtypes are currently recognized: IC/BPS with Hunner's lesions or interstitial cystitis (IC) and IC/BPS without Hunner's lesions or painful bladder syndrome (BPS). IC is an inflammatory disease associated with an immune response and infection, with various histopathological findings and treatment focused on restoring localized lesions in the bladder mucosa; while BPS is a non-inflammatory disorder associated with systemic hypersensitivity probably due to neurophysiological and/or endocrine alterations, with few or even no histological findings and with therapeutic strategies similar to those used in the management of other somatic syndromes. This classification into phenotypes is important because it facilitates the treatment of the disease and favors future research, achieving a better understanding of the pathophysiology and, therefore, of the management of this syndrome. Conclusion: IC/BPS is a pathology of chronic pelvic pain, of still unknown etiology. Several pathophysiological mechanisms have been identified depending on the phenotype, which influence the histopathological findings. Likewise, the clinical manifestations vary depending on the cystoscopy abnormalities. Finally, the therapeutic approach must be individualized and according to the type of this syndrome.