Editorial comment from Dr. Yoshimura to Interstitial cystitis is bladder pain syndrome with Hunner's lesion.

Abstract

During the 3rd International Consultation on Interstitial Cystitis Japan (ICICJ) meeting in Kyoto, a great deal of time was spent on discussing the characteristics of bladder pain syndrome (BPS) type 3C/classic interstitial cystitis (IC) with Hunner's lesion. There has been a long debate on whether BPS type 3C/classic IC with Hunner's lesion and non-Hunner BPS/IC are different phenotypes of the same disease condition or two different disease entities. Although this argument is not yet settled, increasing evidence, as described in this article,1 shows that BPS type 3C/classic IC with Hunner's lesion stands out as a distinct condition with strong inflammatory changes in the bladder (also see the article by Logadottir et al. in this issue).2 In addition, some reports show that resection, coagulation and/or fulguration of Hunner's lesion is effective for relieving pain symptoms in patients with BPS type 3C/classic IC. Based on these observations, during the 3rd ICICJ meeting, it was proposed that the name of IC (interstitial cystitis) could be used for a specific phenotype of BPS that exhibits Hunner's lesion (i.e. BPS type 3C), as outlined in this article. However, as also discussed in this article, there is still no consensus on the prevalence of the classic IC with Hunner's lesion among those diagnosed with BPS. As of today, we still do not have well-defined markers to diagnose Hunner's lesion; therefore, cystoscopic examination is the sole reliable method for identifying it. The use of advanced techniques, such as narrow-band imaging,3 could hopefully lead to the more accurate identification of Hunner's lesion, and even to the clarification of the natural course of progression of Hunner's lesion, which might enable the identification of an “early form” of it. None declared.