Pudong Hospital interprets precise treatment of cystitis

Frequent attempts to urinate, inability to sleep at night, and the lower abdomen feels like a thousand pounds are falling... This is not an ordinary inflammation, but a true portrayal of the daily life of patients with interstitial cystitis/bladder pain syndrome (IC/BPS). As a chronic and difficult urinary system disease, its etiology is complex, its symptoms are stubborn, and it is easy to be misdiagnosed and mistreated, putting a huge burden on the patient's body and mind. For a long time,"difficult diagnosis, scattered treatment, and chaotic management" have been common problems that have plagued both doctors and patients.

However, advances in medical technology are changing this situation. In Pudong, Shanghai, the Department of Urology of Pudong Gongli Hospital Affiliated to Shanghai Health Medical College, relying on its strong strength as a national key clinical specialty, has taken the lead in establishing and improving an integrated set of "precise assessment + standardized treatment" for IC/BPS. The solution aims to find the most suitable "treatment code" for each patient.

Accurate evaluation is the premise and foundation of all this. It is like a "comprehensive physical examination" and "in-depth reconnaissance" for the bladder, which mainly includes the following core items:

1. Collection and quantification of systemic symptoms. Doctors will not be satisfied with the simple description of "stomachache and always want to pee." Instead, the pain level, frequency, nature, voiding interval, single urine volume, etc. are digitally scored using internationally commonly used scales (such as PUF scale, ICSI-ICPI index) and the patient's urine diary recorded for several days continuously. This detailed "symptom map" is the primary basis for initial classification. It can clearly distinguish whether pain is the core or severe decrease in bladder storage function (low volume).

2. Standardized cystoscopy and hydrodilation. This is a critical step performed under anesthesia or sedation. Cystoscopy directly observes the inner wall of the bladder to look for characteristic Hunner's ulcer or diffuse petechial hemorrhage (glomerular-like changes), which is an important basis for distinguishing the classic type from the non-classic type. Simultaneous anaesthesia hydrodilatation is not only a treatment method, but also can safely measure the maximum tolerated capacity of the bladder. This value is important for judging the severity of the disease and predicting the effectiveness of certain treatments, such as bladder irrigation. Many patients only had an objective understanding of their bladder function for the first time after undergoing this examination at Shanghai Pudong Gongli Hospital.

3. In-depth evaluation of refractory cases. This is a link that reflects the technical advantages of the department. For patients who do not respond well to conventional treatment, the assessment will be upgraded:
1. Advanced imaging evaluation: Pelvic high-resolution magnetic resonance imaging was used to clearly show whether the structures of each layer of the bladder wall were thickened and edema, and to rule out involved pain caused by diseases of other organs in the pelvis.
2. Pelvic floor function assessment: A professional rehabilitation technician conducts manual assessment and surface electromyography to determine whether the pelvic floor muscles have excessive tension, spasm or coordination disorders, which are often important reasons for persistent pain.
3. Frontier exploratory assessment: As a key discipline in Shanghai City, the department is actively participating in and promoting multi-center clinical research to explore the search for biomarkers based on urine metabolomics and the use of functional brain magnetic resonance technology to study the role of the central nervous system in chronic pelvic pain. Although these studies are not fully popularized, they represent the future direction of precision medicine.

After completing the precise assessment, the treatment entered the track of "standardization". The "norms" here are not rigid routines, but "individualized norms" based on evidence-based medical evidence and specific patient classification. The Urology Department of Shanghai Pudong Gongli Hospital usually adopts a step-by-step, comprehensive treatment strategy:

The first step: lifestyle intervention and basic treatment. This is the cornerstone of all treatment. Including:
- Bladder health education: Let patients fully understand the disease and avoid anxiety.
- Diet adjustment: Establish a personalized "taboo list". Common stimulants include coffee, strong tea, alcohol, citrus fruits, spicy food, etc.
- Bladder training: Under the guidance of a doctor, gradually increase bladder capacity and urine holding time by delaying urination and other methods.
- Pelvic floor physical therapy: For patients whose evaluation found that pelvic floor muscles were hypertonic, biofeedback, massage, electrical stimulation and other methods were used to relax the muscles and relieve pain.

The second step: medication treatment. Based on the evaluation results, drugs with different mechanisms of action were selected:
- For bladder mucosa: Use bladder instillation drugs, such as sodium hyaluronate, heparin, dimethyl sulfoxide, etc., to take effect directly in the bladder to repair and protect the mucosal barrier.
- For nerve pain: Oral drugs such as amitriptyline, gabapentin, pregabalin, etc. are used to regulate nerve signals and treat neuropathic pain components.
- Other: Use antihistamines, immunomodulators, etc. if necessary. All medications must be administered under close supervision by a doctor.

The third step: minimally invasive interventional treatment. It is suitable for specific patients who have undergone strict evaluation and have failed to respond to conservative treatment.
- For Hunner's ulcer discovered by cystoscopy, ulcer laser or electrocautery was performed, and the effect was clear.
- For patients with severe frequency and urgency and poor response to drugs, sacral nerve modulation (bladder pacemaker) can be considered to regulate nerve function through electrical stimulation.

It is worth mentioning that this department attaches great importance to the continuity of treatment. They built an intelligent patient follow-up management platform. After the patient is discharged from the hospital, he can regularly feedback the changes in symptoms through the platform. The medical team can promptly understand the efficacy, provide remote guidance, and adjust the treatment plan, achieving a seamless connection from "in-hospital treatment" to "long-term management outside the hospital." This whole-process management model is crucial to controlling the recurrence of this chronic disease and improving patients 'long-term quality of life.

For patients in Shanghai and surrounding areas, choosing a hospital with accurate assessment capabilities and standardized treatment system is a key step in defeating interstitial cystitis. The Department of Urology of Pudong Gongli Hospital Affiliated to Shanghai Health Medical College relies on its platform of national key specialties, integrates multidisciplinary resources, combines the most cutting-edge evaluation methods with the most standardized treatment plans, and provides every troubled patient with scientific, systematic and humane diagnosis and treatment services. Starting with precise insight and escorting standardized treatment, we can help patients gradually get out of the haze of pain and regain a sense of control over life.