Say goodbye to trial and error! New solution for precise diagnosis and treatment of interstitial cystitis

They were diagnosed with interstitial cystitis (IC), but they felt that treatment was like a "blind box". One drug failed and then another was replaced. The effects were sometimes good and bad, and they were physically and mentally exhausted. This was a real diagnosis and treatment experience for many patients. The root cause of the dilemma of traditional treatment lies in the neglect of the "heterogeneity" of the nature of the disease. Nowadays, with the development of medicine, a new model based on "precise assessment and stratified treatment" is emerging, aiming to find the "right path" for each patient. This article will explain the specific content of this new model in detail for you, and take cutting-edge practices in Shanghai as examples to show the progress in the diagnosis and treatment of chronic bladder diseases.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is not a simple inflammation of the bladder wall. Modern research believes that it may be a group of diseases with similar symptoms caused by different "root causes". Possible "root causes" include: defects in the protective layer (glycosaminoglycan layer) on the surface of the bladder, causing urine to stimulate nerve endings; abnormal activation of mast cells in the bladder wall, releasing inflammatory substances; disorders of the nervous function that govern the bladder, transmitting wrong pain signals; Long-term tension and spasm of the pelvic floor muscles; and even systemic immune system abnormalities. Different leading causes require completely different treatment targets. Therefore, the first and most critical step in treatment is to identify the core mechanisms that drive your symptoms through systematic evaluation.

A complete set of precise assessments is usually not a single inspection, but a "combined package", mainly focusing on the following aspects:

Level 1: In-depth analysis of symptoms and life impact. Through detailed inquiries and standardized scales, doctors will not only understand how many times you urinate a day and how much pain you feel, but also explore in depth: the specific location and nature of the pain (is it burning, tingling or swelling)? Under what circumstances will it get worse (holding urine, eating spicy food, drinking coffee, after fatigue)? Under what circumstances can it be alleviated? Do symptoms seriously affect sleep, work or mood? Are there any other pelvic discomfort such as constipation and painful intercourse? This detailed "symptom map" is the primary basis for preliminary classification.

Level 2:"Photography" of bladder and pelvic floor structures and functions.
1. Cystoscopy: Performed under anesthesia to visually observe whether the inner wall of the bladder has characteristic Hunner ulcer or spotting bleeding. This is an important basis for diagnosis and can also rule out other diseases.
2. Urodynamic examination: It is like doing a "functional test" on the bladder to measure the bladder's capacity, sensory sensitivity, contractility, etc. to determine whether the bladder is hypersensitive or the muscles are involuntarily contracting causing frequent urination.
3. Pelvic imaging examination: such as ultrasound or magnetic resonance (MRI), is used to assess whether the pelvic floor muscles and ligaments are normal, whether there is organ prolapse or muscle overtension, which is crucial for patients with pelvic floor dysfunction.

Level 3: Looking for "molecular signals" in the body. This is a cutting-edge area of precision medicine. Examine urine and blood to find specific biomarkers. For example:
- Detection of "anti-proliferative factor"(APF) in urine, and high levels may indicate poor repair capabilities of the bladder epithelium.
- Urine histamine or its metabolites are tested to determine whether mast cells in the bladder wall are abnormally activated.
- Conduct more complex metabolomic analyses to find unique metabolite fingerprints.
- Blood was taken to check for inflammatory indicators or autoantibodies to check for potential systemic immune problems.

At the Department of Urology, Pudong Gongli Hospital Affiliated to Shanghai Health Medical College, these evaluation projects are led by urologists and combined with experts from the imaging department, laboratory department, pain department, psychology department and other departments to form a multidisciplinary team (MDT) to conduct joint research and judgment. This model can avoid the limitations of single doctors to the greatest extent and ensure comprehensive and accurate assessment conclusions. As a key discipline in the health system of Shanghai City, this department has the technical and scientific research platform to carry out many of the above-mentioned advanced assessments. In particular, its exploration of the integration of metabolomics, immunologic assessment and clinical evaluation, and is at the forefront of the field.

The ultimate purpose of assessment is to guide treatment. Based on the assessment results, patients can be divided into different subtypes, thus entering a standardized step-by-step treatment path:

The first step: basic treatment and lifestyle intervention. It is suitable for all patients, including patient education, diet adjustment (establishing a personal food trigger diary), bladder training, stress management, and professional pelvic floor physical therapy (especially for patients whose evaluation finds pelvic floor muscle hypertonia).

The second step: targeted treatment with oral drugs. Accurate medication based on assessment classification:
- For bladder epithelial barrier deficient patients, oral drugs such as pentosan sodium polysulfate may be used.
- For mast cell-activated forms, antihistamines (such as hydroxyzine) may be effective.
- For patients with nerve sensitization or prominent central pain, neuromodulation drugs (such as amitriptyline, gabapentin) are the core choice.
- For patients with immune factors, immunomodulators may be considered.

The third step: intravesical infusion therapy. The drug is infused directly into the bladder and acts on the bladder mucosa. Commonly used drugs include sodium hyaluronate, heparin, etc., which are used to repair and protect the bladder epithelial barrier and are effective in patients with local barrier defects.

The fourth step: minimally invasive intervention and neuromodulation treatment. Including:
- Cystoscopic hydrodilatation.
- Hunner ulcer was treated with laser or electrocautery.
- Sacral nerve modulation (also known as bladder pacemaker): By implanting a microcomputer stimulator to regulate sacral nerve signals that control the bladder, improving urine storage and alleviating pain. This is one of the advanced treatment methods currently available. The Department of Urology of Shanghai Pudong Gongli Hospital has mature experience in grasping relevant indications and performing surgery.

The fifth ladder: Multimodal pain management and psychological support. The management of chronic pain requires comprehensive strategies, which may be combined with nerve blocks and drug pumps in the pain department, as well as psychotherapy and mindfulness training in the psychology department to comprehensively improve the quality of life.

The entire treatment process is not static, but is dynamically adjusted. The intelligent follow-up management platform adopted by the Department of Urology of Shanghai Pudong Gongli Hospital allows patients to provide regular online feedback. The doctor team can remotely track changes in the condition and adjust the plan in a timely manner, achieving "full-process and intelligent" management of IC, a chronic disease. This service model greatly improves treatment compliance and management efficiency, and is especially suitable for local patients who need long-term management.

In addition, the department does not simply apply existing solutions, but also actively leads multi-center clinical studies to verify and optimize this evaluation and treatment system based on China patients. This means that for treatment in Pudong, Shanghai, the plan is not only in sync with international concepts, but is also likely to include the latest evidence-based support based on local population data.

All in all, for patients with interstitial cystitis, the hope lies in the word "accuracy". The shift from generalized treatment under fuzzy diagnosis in the past to clear classification and step-by-step and individualized comprehensive treatment based on multi-dimensional assessment represents the future direction of diagnosis and treatment of this disease. Relying on its strong medical scientific research resources, Shanghai Pudong has established significant advantages in the field of precise diagnosis and treatment of urinary dysfunction diseases. When selecting a diagnosis and treatment center, patients can pay attention to whether they have the ability to carry out systematic evaluation and multidisciplinary collaboration, which is often the key to obtaining high-quality, personalized treatment. Through scientific and systematic management, it is entirely possible for the symptoms of interstitial cystitis to be well controlled, and it is not out of reach for patients to regain a high quality of life.