Editorial Comment to Clinical guidelines for interstitial cystitis/bladder pain syndrome.

Abstract

The former Japanese Clinical Guidelines for interstitial cystitis (IC) and related conditions was published in 2009 and 2016.1 Homma et al. revised the previous guidelines, completing articles identified by the PubMed database published from 2016 to 2019.2 In the current clinical guidelines, one of the characteristics is the categorization. IC/bladder pain syndrome (BPS) is utilized as a comprehensive term, and divided into Hunner-type IC (HIC) and BPS. Only HIC represents Hunner lesions, thus endoscopic findings are indispensable for the diagnosis. Hunner lesion is introduced as a reddish lesion associated with converging vessels, covering fibrin clots or scars, and in this guideline, multiple characteristic endoscopic pictures are shown for reference. The authors have first provided a histopathology section in this guideline, because a recent study showed the histological difference between HIC and BPS.3 It has been reported that HIC shows an immunological inflammatory reaction accompanied by B-cell clonal expansion and epithelial denudation, whereas BPS shows few changes. Treatments for IC/BPS were listed in the order of conservative, medical, intravesical instillation, endoscopy surgery, cystectomy and other treatments. Conservative treatment includes patient education, meditation and a strict dietary therapy. Medical treatments, including new evidence of pentosane polysulfate, cyclosporine A and antibacterial agents, have been added, and certolizumab and tacrolimus have been newly added. Dimethyl sulfoxide instillation therapy still requires information; however, a randomized study showed that efficacy favored HIC.4 Chondroitin sulfate, botulinum toxin and steroids instillation were also introduced. Endoscopic hydrodilation and transurethral fulguration are still effective. Cystectomy would be the last resort. The clinical algorithm shows how to care for IC/BPS patients. Electrostimulation, such as sacral nerve neuromodulation and acupuncture, are introduced in the other treatments section. The algorithm provides a useful approach in the treatment of patients. To validate the therapeutic effectiveness of the treatments, the patients should be specified to IC/BPS, HIC alone or BPS alone. Future clinical studies are still necessary; however, this clinical guideline would help open a new window in understanding the pathophysiology and provide better management for urologists in this field. None declared.