Pudong, Shanghai: Detailed assessment and stratified treatment of interstitial cystitis

The diagnosis of "interstitial cystitis/bladder pain syndrome (IC/BPS)" may not be unfamiliar to many patients suffering from frequent frequency, urgency, increased nocturnal urine, and refractory pain in the lower abdomen and pelvic areas. However, diagnosis is only the beginning of a long treatment journey. Faced with this chronic disease with complex causes and diverse manifestations, many patients and family members are full of questions: Why do I still have pain and frequent urination after taking so many medicines? Is there a more precise way to find the cause and prescribe the right medicine?

Traditionally, the diagnosis and treatment of interstitial cystitis relies on symptom description and limited examinations, such as urine routine, cystoscopy, etc. Treatment also often adopts a "trial and error method", and one plan is not effective before another is tried. This pattern often leads to long treatment cycles and physical and mental exhaustion for patients. Nowadays, with the advancement of medical concepts, especially in areas with abundant medical resources such as Pudong, Shanghai, the diagnosis and treatment of such difficult chronic bladder diseases is undergoing a profound transformation from "empirical" to "precise and hierarchical". Change.

Accurate assessment: Multi-dimensional "reconnaissance" points out the direction for treatment

To win a battle, we must first accurately detect the enemy's situation. For interstitial cystitis, the prerequisite for precise treatment is comprehensive, multi-dimensional and precise assessment. This is no longer a one-on-one fight by a single department, but requires a team of "joint operations of multiple arms." Taking the Department of Urology (national key clinical specialty) of Pudong Gongli Hospital Affiliated to Shanghai Health Medical College as an example, the evaluation system it has constructed reflects this integrated thinking.

The first is a refined assessment of clinical symptoms and life impact. Doctors will use a structured questionnaire to not only record the degree, location and nature of frequent urination, urgency, and pain, but also gain an in-depth understanding of the association between pain and urination, diet, mood, and menstrual cycle, as well as the disease's impact on patients 'sleep, work, social interaction and mental health. This is like drawing a detailed "symptom map" that provides the basis for subsequent analysis.

Second, there is an in-depth functional and structural evaluation. In addition to routine urinalysis and urinary ultrasound, hydrodilatory cystoscopy is still one of the important diagnostic tools. However, modern assessments pay more attention to their "discovery" value-observing typical changes in the bladder mucosa (such as spotting hemorrhage, Hunner's ulcer), and conducting precise pathological biopsies under the microscope to clarify the inflammation and nerve distribution of the mucosa layer. Urodynamic examination can objectively assess the urine storage and voiding functions of the bladder, and determine whether there are comorbidities such as overactivity of the bladder or voiding dysfunction.

The key breakthrough lies in the third level: interdisciplinary in-depth mechanism exploration. This is the advantage of key specialties such as the Department of Urology at Shanghai Pudong Gongli Hospital. They collaborated in depth with imaging, metabolomics, immunology and other teams to push the assessment to a deeper level:

1. Functional magnetic resonance imaging (fMRI): Studies have shown that patients with chronic pelvic pain may have abnormal functional connections in areas related to pain processing in the brain (such as anterior cingulate gyrus and insular lobe). Through fMRI evaluation, the central sensitization mechanism of pain can be partially revealed, that is, the brain's amplification of pain signals, which provides a basis for explaining why local stimulation can cause a violent systemic reaction.
2. Urine metabolomic analysis: Urine contains a large amount of metabolic end products. By analyzing metabolite profiles in urine through high-throughput technology, it is possible to discover specific metabolic marker groups associated with interstitial cystitis. This is like looking for a "chemical fingerprint" of a disease in urine, which not only helps assist diagnosis, but may also point to specific metabolic pathway abnormalities and provide clues for targeted intervention.
3. Immune and inflammatory factor testing: Detecting the levels of specific cytokines and chemokines in blood or urine can help determine whether there is abnormal immune activation or chronic inflammatory state in the patient's body, thereby distinguishing different inflammatory subtypes.

Through this multi-dimensional evaluation system of "symptom phenotype + organ function + central mechanism + molecular markers", doctors are able to more clearly depict each patient's unique disease "portrait" and identify the core mechanism that dominates his condition-is it a local bladder mucosal barrier defect? Is it neurogenic inflammation? Is central sensitization leading? Or are multiple factors intertwined?

Stratified diagnosis and treatment: from "one size fits all" to "tailored"

Based on the results of accurate evaluation, treatment is no longer a "one-person party" approach, but has entered a new stage of "hierarchical diagnosis and treatment." Treatment strategies are stratified and combined based on the main contradictions revealed by the assessment:

Layer 1: Treatment for bladder mucosal barrier repair. For patients whose evaluation found obvious defects in the bladder mucosa (Glycosaminoglycan layer), the treatment plan will focus on bladder infusion therapy, such as the use of sodium hyaluronate, heparin and other drugs to directly replenish and repair the protective layer on the bladder surface and reduce the stimulation of harmful substances in the urine on bladder wall nerves.

Layer 2: Treatment of neurogenic inflammation and pain. If the assessment suggests that nerve inflammation or peripheral nerve sensitization is the main problem, treatment will include drugs targeting nerves, such as gabapentin, pregabalin, etc., or consider intravesical infusion of local anesthetics, botulinum toxin A injection, etc., to stabilize nerves and reduce pain signaling.

The third level: Comprehensive management for central sensitization. When functional brain imaging and other indicators suggest significant central sensitization, treatment must go beyond the local bladder. This requires integrating the power of pain medicine, rehabilitation medicine and psychology. Psychological interventions such as cognitive-behavioral therapy and mindful decompression can help adjust the cognition and response to pain; physical therapy (such as pelvic floor myofascial manual release, neuromodulation techniques) can relieve local muscle tension and nerve compression; While certain antidepressants (such as tricyclic drugs and SNRIs) regulate emotions, they also regulate the central pain pathway.

The fourth level: Adjustment for comorbidities and general status. Interstitial cystitis is often comorbidities with irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, etc. Treatment requires overall management, including lifestyle interventions such as diet adjustments (such as trying a low-acid and low-histamine diet), sleep management, and stress regulation to improve overall health.

As a key discipline in this field, the urology department of Shanghai Pudong Gongli Hospital is a reflection of this hierarchical concept. They not only took the lead in conducting multi-center real-world research, exploring and improving this multi-dimensional evaluation and hierarchical treatment system, but also built an integrated chronic disease management model in practice. Through the intelligent follow-up management platform, patients can regularly report back on changes in symptoms, and the medical team can track the efficacy and adjust the plan in a timely manner to achieve dynamic optimization and long-term management of treatment, significantly improving the accessibility and continuity of treatment.

For patients with interstitial cystitis in Shanghai, it is of great significance to understand and seek this precise hierarchical diagnosis and treatment model. It means saying goodbye to blind trial and error and turning to targeted targets. Although the disease cannot be "eradicated" at present, it is entirely possible to achieve significant control of symptoms, great improvement in quality of life, and even long-term clinical remission through precise evaluation to clarify the main direction of attack, and then apply stratified and comprehensive personalized treatment. This is not only an advancement in technology, but also a vivid practice of the concept of patient-centered medical care.