[New insights in the differential diagnosis of bladder pain syndrome]

Aktuelle Urol. 2010 Mar;41(2):107-18. doi: 10.1055/s-0030-1247272. Epub 2010 Mar 22.
[Article in German]

Abstract

The diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC) is challenging, since pathogenetic mechanisms and the definition of clinical relevant parameters are still under lively discussion. The criteria recently proposed by the European Society for the Study of Interstitial Cystitis (ESSIC) define a collective of patients based on the cardinal symptom of bladder pain which is heterogeneous, and therefore cannot receive standardised consistent therapy. Thus an extended diagnosis based on molecular markers seems to be indicated to render individual pharmacotherapy possible, and to contribute to elucidation of BPS/IC pathogenesis. For this purpose we feel the vital need for taking a bladder biopsy. The diagnosis of BPS/IC should rely on 3 "columns": (1) clinical diagnostics; (2) histopathology; (3) molecular diagnostics/protein expression. Since a significant contribution of the 3 functional units of the bladder to the pathophysiology is most evident, the examinations should ideally include urothelium, lamina propria, and detrusor musculature. Generation of receptor profiles of the detrusor muscle represents a first attempt to define a diagnostic tool for the individualisation of BPS/IC pharmacotherapy. Other factors, e.g., beta-hCG expression in the urothelium, need further evaluation. Extended BPS/IC diagnostics could be realistically integrated into routine patient care within a clinic/laboratory network.

Publication types

  • English Abstract
  • Review

MeSH terms

  • Biopsy
  • Capillaries / pathology
  • Capillaries / physiopathology
  • Chorionic Gonadotropin, beta Subunit, Human / genetics
  • Cystitis, Interstitial / classification
  • Cystitis, Interstitial / diagnosis*
  • Cystitis, Interstitial / drug therapy
  • Cystitis, Interstitial / pathology
  • Cystoscopy
  • Diagnosis, Differential
  • Gene Expression / physiology
  • Humans
  • Mast Cells / pathology
  • Mast Cells / physiology
  • Mucous Membrane / pathology
  • Mucous Membrane / physiopathology
  • Nerve Fibers / pathology
  • Nerve Fibers / physiology
  • Practice Guidelines as Topic
  • Receptors, G-Protein-Coupled / genetics
  • Risk Factors
  • Urinary Bladder / pathology
  • Urinary Bladder / physiopathology
  • Urinary Bladder, Overactive / classification
  • Urinary Bladder, Overactive / pathology
  • Urinary Bladder, Overactive / physiopathology
  • Urothelium / pathology
  • Urothelium / physiopathology

Substances

  • Chorionic Gonadotropin, beta Subunit, Human
  • Receptors, G-Protein-Coupled