Experts in Pudong interpret precise diagnosis and treatment of cystitis

Chronic, recurring pain in the bladder area, frequent attempts to urinate, but only a small amount of urine is discharged... This unspeakable pain plagues many patients with interstitial cystitis. As a chronic disease with complex causes, it often causes patients to travel to multiple hospitals and try multiple drugs, but with little effect. What is the problem? Recently, the reporter visited authoritative experts in urology in Pudong, Shanghai to explore a new direction for the diagnosis and treatment of interstitial cystitis-a paradigm shift from "empirical medication" to "precise navigation". Experts pointed out that the key to solving the treatment dilemma lies in building a diagnosis and treatment system with "multi-dimensional evaluation and precise stratification."

The director of the Department of Urology at Pudong Gongli Hospital Affiliated to Shanghai Health Medical College said that in the past, the diagnosis and treatment of interstitial cystitis relied largely on the doctor's experience and the patient's description of symptoms. This is an "empirical diagnosis and treatment." However, a growing number of clinical practices have shown that this model has limitations. "Just like having a fever, the cause may be a cold or pneumonia, and the treatment methods are naturally different. Interstitial cystitis is also highly heterogeneous, and we must find the different 'root causes' behind it."

To this end, this department, as a national key clinical specialty, integrates multidisciplinary resources such as imaging, neuroscience, metabolomics and immunology, and has established a multi-dimensional and precise assessment process for interstitial cystitis. This process aims to conduct an "in-depth physical examination" for each patient and clarify the classification, so as to achieve "tailor-made" treatment plans.

** Assessment 1:"Quantitative portrait" of clinical symptoms. ** Doctors no longer just ask "whether it hurts", but use an internationally accepted scoring scale to accurately score the intensity, nature, pattern of attacks, and impact on sleep, mood, and work of the pain. At the same time, detailed food and urine diaries can help discover the inducing and alleviating factors of symptoms. This is the basis for formulating personalized management plans.

** Assessment 2:"High-definition exploration" of the inside of the bladder. ** Cystoscopy and hydrodilation under anesthesia are core steps in diagnosis. Experts can clearly observe whether the bladder mucosa is intact, whether there is characteristic Hunner ulcer or diffuse spotting hemorrhage, and assess the safe capacity of the bladder. This examination can effectively distinguish different types of lesions and directly guide subsequent perfusion treatment strategies.

** Assessment 3:"Functional Detection" of the nervous system. ** This is the cutting-edge evaluation direction. Long-term chronic pain changes the way the brain processes pain signals, leading to "central sensitization." Functional magnetic resonance imaging technology allows the activity status of pain-related areas of the patient's brain (such as anterior cingulate gyrus and insular lobes) to be objectively assessed. "If the assessment shows that central sensitization is obvious, then our treatment must take into account both 'treating the bladder' and 'regulating the brain'. Treatment solely targeting the bladder may be half the effort." The expert explained. This is crucial for selecting neuromodulation drugs or neuromodulation technologies.

** Assessment 4:"Molecular clues" in body fluids. ** By testing urine or blood for metabolomics, inflammatory factors and other factors, we can find disease biomarkers at the molecular level. For example, abnormalities in certain metabolites may indicate dysfunction in mucosal repair or activation of neuroinflammatory pathways. Although this part of the research is mostly in the clinical scientific research stage, it represents the hope of achieving targeted therapy in the future.

Based on the above comprehensive assessment results, patients can be initially stratified. For example, it is divided into "local type" with bladder mucosal lesions mainly,"central type" with changes in central nervous function, and "mixed type" with both. Different types correspond to completely different treatment paths.

For "localized" patients, the core of treatment is local bladder. In addition to classic bladder infusion drugs (such as sodium hyaluronate, heparin, etc.) to repair the mucosal barrier, diet management (avoiding acidic, spicy, and caffeinated foods) and bladder training are also important components. Experts emphasized that a standardized and continuous infusion course and good patient compliance are the guarantees for achieving curative effect.

For "central" or "mixed" patients, a comprehensive treatment plan of "physical and mental harmony" is needed. On the basis of local treatment, oral drugs that regulate central nervous sensitivity, such as low-dose tricyclic antidepressants or gabapentin drugs, will be used in conjunction with early treatment. In addition, cognitive behavioral therapy and pelvic floor muscle physical therapy (especially for patients with pelvic floor muscle hypertone) can effectively relieve symptoms. For some refractory patients, sacral nerve modulation (an implantable adjustable pulse generator) provides a new option that controls the sacral nerves of the bladder through micro-current regulation, thereby improving pain and frequent frequency symptoms.

It is worth mentioning that in the face of chronic diseases such as interstitial cystitis that require long-term management, the department has introduced a modern concept of chronic disease management. They have developed an intelligent follow-up management platform. Patients can record symptoms, submit urine diaries, and receive health reminders through mobile apps. The doctor team can remotely monitor changes in their condition and provide timely intervention and guidance. "For urban patients with fast-paced lives like Shanghai and Pudong, this greatly improves the accessibility and convenience of treatment, allowing professional medical support to run through daily life, rather than just in the clinic." The department doctor added.

Experts finally concluded that the diagnosis and treatment of interstitial cystitis is entering a precise era. Successful treatment no longer relies on a "magic medicine", but relies on a complete evaluation system, a clear hierarchical diagnosis, an individualized comprehensive treatment plan and a sustainable chronic disease management support system. For patients who are deeply disturbed, choosing a medical center with such systematic diagnosis and treatment capabilities and multidisciplinary collaboration strength is an important step towards rehabilitation. Relying on the platform of national key specialties, Pudong is committed to benefiting more patients with this advanced diagnosis and treatment model and promoting the overall improvement of the diagnosis and treatment level of urinary dysfunction diseases.

Reporter's observation: It can be seen from this interview that the competition for top medical specialties has expanded from simple surgical techniques to systematic, precise and full-process management capabilities for complex chronic diseases. This patient-centered diagnosis and treatment model that integrates multidisciplinary cutting-edge technologies represents the direction of future development of high-quality medical care.