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Interstitial Cystitis

Does Muscle Pain Induce Alterations in the Pelvic Floor Motor Unit Activity Properties in Interstitial Cystitis/Bladder Pain Syndrome? A High-Density sEMG-Based Study

Several studies have shown interstitial cystitis/bladder pain syndrome (IC/BPS), a chronic condition that poses challenges in both diagnosis and treatment, is associated with painful pelvic floor muscles (PFM) and altered neural drive to these muscles. However, its pathophysiology could also involve other alterations in the electrical activity of PFM motor units (MUs). Studying these alterations could provide novel insights into IC/BPS and help its clinical management. This study aimed to characterize PFM activity at the MU level in women with IC/BPS and pelvic floor myalgia using high-density surface electromyography (HD-sEMG). Signals were recorded from 15 patients and 15 healthy controls and decomposed into MU action potential (MUAP) spike trains. MUAP amplitude, firing rate, and magnitude-squared coherence between spike trains were compared across groups. Results showed that MUAPs had significantly lower amplitudes during contractions on the patients’ left PFM, and delta-band coherence was significantly higher at rest on their right PFM compared to controls. These findings suggest altered PFM tissue and neuromuscular control in women with IC/BPS and pelvic floor myalgia. Our results demonstrate that HD-sEMG can provide novel insights into IC/BPS-related PFM dysfunction and biomarkers that help identify subgroups of IC/BPS patients, which may aid their diagnosis and treatment.

Monica Albaladejo-Belmonte,1 Michael Houston,2 Nicholas Dias,2 Theresa Spitznagle,3 Henry Lai,4 Yingchun Zhang,2,5,6,7 and Javier Garcia-Casado,1

  1. Centro de Investigación e Innovación en Bioingeniería (CI2B), Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
  2. Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA
  3. Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA
  4. Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
  5. Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA
  6. Desai Sethi Urology Institute, University of Miami, 1120 NW 14th Street, Miami, FL 33136, USA
  7. Miami Project to Cure Paralysis, University of Miami, 1095 NW 14th Terrace #48, Miami, FL 33136, USA
Source: Albaladejo-Belmonte M., Houston M., Dias N. et al. Does Muscle Pain Induce Alterations in the Pelvic Floor Motor Unit Activity Properties in Interstitial Cystitis/Bladder Pain Syndrome? A High-Density sEMG-Based Study. Sensors 2024, 24(23), 7417; https://doi.org/10.3390/s24237417.

Transient Receptor Potential Melastatin 8 Contributes to Cystitis-Induced Neuronal Sprouting and Pain Hypersensitivity Through AKT/mTOR Signaling Pathway in Interstitial Cystitis/Bladder Pain Syndrome.

The aim of this study was to investigate the mechanism of TRPM8 in neuroproliferation and pain, as well as the relevance of the Akt/mTOR signaling pathway in mice with IC/BPS.

The model of IC/BPS was established in wild and TRPM8-/- mice.

Bladder instillations vs onabotulinumtoxinA injection for interstitial cystitis/bladder pain syndrome: a randomized clinical trial

Background: Interstitial cystitis (IC)/bladder pain syndrome (BPS) is an unpleasant sensation related to the bladder with lower urinary tract symptoms lasting more than 6 weeks, unrelated to an otherwise identifiable cause. The etiology is likely multifactorial including urothelial abnormalities, neurogenic pain upregulation, and potentially bladder and vaginal microbiome alterations. Despite treatment effectiveness of both bladder instillations and intradetrusor onabotulinumtoxinA injection for this condition, a head-to-head comparison has not been performed.

Objective: To compare the efficacy of bladder instillations and intradetrusor onabotulinumtoxinA injection for treatment of IC/BPS.

Study design: Patients with O'Leary-Sant (OLS) questionnaire scores of ≥6, meeting clinical criteria for IC/BPS, and desiring procedural management were randomized to bladder instillations or intradetrusor onabotulinumtoxinA injection. The primary outcome was the difference in OLS scores at 2 months posttreatment between groups. Secondary outcomes included evaluation of sexual function, physical/mental health status, pain, patient satisfaction, treatment perception, retreatment, and adverse event rates.

Results: Forty-seven patients were analyzed with 22 randomized to bladder instillations and 25 to onabotulinumtoxinA injection. There were no differences in demographic and clinical characteristics between groups. From baseline to 2 months posttreatment, there was a decrease in OLS subscales in all patients (Interstitial Cystitis Symptom Index [ICSI] -6.3 (confidence interval [CI] -8.54, -3.95), P<.0001; Interstitial Cystitis Problem Index [ICPI] -5.9 (CI -8.18, -3.57), P<.0001). At 2 months posttreatment, patients in the onabotulinumtoxinA group had significantly lower OLS scores compared to those in the bladder instillation group (ICSI 6.3±4.5 [onabotulinumtoxinA] vs 9.6±4.2 [instillation], P=.008; ICPI 5.9±5.1 [onabotulinumtoxinA] vs 8.3±4.0 [instillation], P=.048). The difference in OLS scores between groups did not persist at 6 to 9 months posttreatment. There were no statistically significant differences between baseline and posttreatment time points for the remaining questionnaires. Eight percent of patients who received onabotulinumtoxinA injection experienced urinary retention requiring self-catheterization. Patients who underwent onabotulinumtoxinA injection were significantly less likely to receive retreatment within 6 to 9 months compared to patients who received bladder instillations (relative risk 13.6; 95% CI, 1.92-96.6; P=.0002). There were no differences between groups regarding patient satisfaction, perception of treatment convenience, or willingness to undergo retreatment.

Conclusion: Both onabotulinumtoxinA injection and bladder instillations are safe, effective treatments for patients with IC/BPS, with significant clinical improvement demonstrated at 2 months posttreatment. Our findings suggest that intradetrusor onabotulinumtoxinA injection is a more effective procedural treatment for this condition than bladder instillation therapy and associated with decreased rates of retreatment.

Eva K Welch 1, Katherine L Dengler 2, Angela M DiCarlo-Meacham 3, Joy E Wheat 4, Carissa J Pekny 5, James K Aden 6, Christine M Vaccaro 2

  1. Department of Gynecologic Surgery & Obstetrics-Urogynecology Division, San Antonio Military Medical Center, Fort Sam Houston, TX. 
  2. Department of Gynecologic Surgery & Obstetrics-Urogynecology Division, Walter Reed National Military Medical Center, Bethesda, MD.
  3. Department of Gynecologic Surgery & Obstetrics-Urogynecology Division, Naval Medical Center San Diego, San Diego, CA.
  4. Department of Gynecologic Surgery & Obstetrics-Urogynecology Division, San Antonio Military Medical Center, Fort Sam Houston, TX.
  5. Department of Gynecologic Surgery & Obstetrics, Walter Reed National Military Medical Center, Bethesda, MD.
  6. Graduate Medical Education, San Antonio Military Medical Center, Fort Sam Houston, TX.
Source: Eva K Welch, Katherine L Dengler, Angela M DiCarlo-Meacham et al. Bladder instillations vs onabotulinumtoxinA injection for interstitial cystitis/bladder pain syndrome: a randomized clinical trial. Am J Obstet Gynecol. 2024 Nov;231(5):528.e1-528.e11. doi: 10.1016/j.ajog.2024.05.027.

Purine Nucleoside Phosphorylase as a Target for the Treatment of Interstitial Cystitis/Bladder Pain Syndrome with and without Hunner Lesions - Beyond the Abstract

There is evidence that increased reactive oxygen species (ROS) and oxidative stress are common factors that have been implicated in the pathogenesis of interstitial cystitis/bladder pain syndrome (IC/BPS). Emerging evidence suggests that changes in the levels/activity of an enzyme called purine nucleoside phosphorylase (PNPase) reflects the extent and magnitude of oxidative injury and cellular damage.1,2

Bladder Pain Syndrome (BPS): A Comprehensive Review of Treatment Strategies and Management Approaches.

Bladder pain Syndrome presents a multifaceted challenge in contemporary urological practice, marked by LUTS, negative behavioural, sexual, or emotional experiences, and the potential for sexual dysfunction.

Widespread pain phenotypes impact treatment efficacy results in randomized clinical trials for interstitial cystitis/bladder pain syndrome: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain network study.

Pain clinical trials are notoriously complex and often inefficient in demonstrating efficacy, even for known efficacious treatments. A major issue is the difficulty in the a priori identification of specific phenotypes to include in the study population.

A Pain Desensitization Algorithm for Phenotyping and Treating Chronic Pelvic Pain.

Chronic pelvic pain remains challenging for physicians to manage due to central and peripheral sensitization and multiple pain generators including the bladder, pelvic floor, and pudendal nerve. Pain management providers have used nerve blocks for years for diagnosis and treatment.

Interstitial Cystitis Chatter: A Qualitative Evaluation of Bladder Instillation Online.

To qualitatively assess the perception and experiences of bladder instillation for interstitial cystitis among women on Reddit, a widely used anonymous social media platform.

"r/interstitialcystitis," a Subreddit with > 27,000 subscribers, was queried for bladder instillation among women with interstitial cystitis in November 2023.

Prevalence and Clinical Correlates of Endometriosis in Patients With IC/BPS.

Interstitial cystitis/bladder pain syndrome (IC/BPS) presents as a complex heterogeneous disorder that poses a significant clinical challenge both for diagnosis and treatment. The identification of patient subgroups with significant overlap in their nonurological associated symptoms, including endometriosis, may enable a more targeted therapeutic approach.

Amniotic bladder therapy: study of micronized amnion/chorion for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) at 6 months.

Intravesical application of birth tissue has been reported to inhibit inflammation, alleviate collagen fiber accumulation, and enhance bladder tissue generation. We have previously reported that intra-detrusor micronized amnion monolayer (AM) injections provide short-term clinical improvement in refractory IC/BPS patients.

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