Definition Change and Update of Clinical Guidelines for Interstitial Cystitis and Bladder Pain Syndrome - Beyond the Abstract
IC is a renowned word coined in the 19th century. The patients complained of severe bladder pain and urinary frequency, and the bladder showed characteristic lesions (Hunner lesions) in the bladder. Later, a mimicking condition with similar symptoms but lacking Hunner lesions was recognized. This condition was regarded as a variant of IC, and given multiple names, for example, non-Hunner IC, painful bladder syndrome, hypersensitive bladder, and most recently, BPS. Anyway, there has been an assumption that IC and related conditions such as BPS are different phenotypes of the same disease. This assumption is manifested by the writing IC/BPS.
However, recent evidence has clearly indicated that IC and BPS are biologically not related or of different diseases. IC is an immune-inflammatory disorder most probably resulting from autoimmunity, while BPS is likely to be associated with neural hyperactivity. Thus, the current article avoided a misleading connecting word, IC/BPS, but used “IC and BPS” to show visibly the difference between these two disorders. It also recommends cystoscopy for the right diagnosis. Naturally, clinical management and research are to be considered differently for IC and BPS.
This modification of terminology is not a conceptual play. The right management cannot be achieved without the right diagnosis. Confusion or misdiagnosis of IC and BPS makes it difficult to deliver the appropriate therapy to patients suffering from devasting symptoms. This symptom complex such as bladder pain and urinary frequency is collectively referred to as hypersensitive bladder symptoms in the article. The close similarity of symptoms has made us confuse IC and BPS. In the future, we will see two clinical guidelines: one for IC and the other for BPS.
Written by: Yukio Homma, Professor, Department of Interstitial Cystitis Medicine, Kyorin University, Mitaka, Japan
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