Detailed explanation of interstitial cystitis: symptoms, diagnosis and Pudong's new diagnosis and treatment model

In the urology clinic, we often encounter some patients with sad faces, especially women. Their complaints are highly consistent: they always want to urinate and their bladder is always painful. However, after checking urine routine and B-ultrasound, the doctor said,"Nothing big problem." This kind of "undetectable pain" and "unstopped urge to urinate" greatly reduces the quality of life and brings a huge psychological burden. Today, let's take an in-depth discussion of this disease that plagues many patients-interstitial cystitis/bladder pain syndrome (IC/BPS), and see how medical centers represented by Shanghai Pudong area apply new concepts and new technologies to meet this challenge.

First, we need to "correct the name" for interstitial cystitis. It is not a single disease, but a clinical syndrome. You can think of it as a "basket" of multiple conditions that may have different causes but present similar core symptoms (i.e. bladder pain accompanied by frequent urination). The fundamental problem is that the protective layer (glycosaminoglycan layer) of the bladder mucosa may be defective, making it easier for irritating substances in the urine to penetrate into the interstitial tissue deep in the bladder wall, causing chronic inflammation, nerve endings sensitization, and even tissue fibrosis. This is like after the skin barrier is damaged, slight contact with external stimuli will cause redness, swelling and pain.

Therefore, its diagnosis is an "exclusive" and "comprehensive" process. Doctors need to first rule out diseases with similar symptoms but a clear cause, such as infectious cystitis, bladder tumors, urinary stones, endometriosis invading the bladder, etc. After these possibilities are ruled out, a diagnosis can be made by combining the characteristic symptoms and the findings of certain special examinations. Among them, hydrodilating cystoscopy is an important tool. Fluid is injected into the bladder under anesthesia to dilate it. If the bladder mucosa shows typical glomerulations, or more characteristic Hunner ulcer, the diagnosis of interstitial cystitis is strongly supported. However, not all patients have typical manifestations under cystoscopy, which makes diagnosis more difficult.

This is why modern urological diagnosis and treatment is moving towards "precision" and "stratification". Faced with diagnostic gray areas and disease heterogeneity, leading medical centers are no longer satisfied with binary "yes or no" diagnoses, but are committed to answering "which type" and "why is this?" For example, the Department of Urology at Pudong Gongli Hospital Affiliated to Shanghai Health Medical College, as a key discipline in Shanghai City, is taking the lead in conducting real-world research and exploring an evaluation system based on multi-omics technology. This means that they try to find answers at a more microscopic level: using metabolomics to analyze differences in hundreds of small molecule metabolites in patients 'urine to find biomarkers related to the occurrence and development of the disease; using immunological testing to explore whether there is abnormal immune response locally or systemically in the bladder; and even using functional magnetic resonance imaging to study whether there are abnormal functional connections in areas of the patient's brain that handle pain and bladder sensations. This multi-dimensional "investigation" aims to draw a unique picture of the disease for each patient.

Based on precise assessment of classification, treatment can be truly "targeted". At present, IC/BPS treatment is characterized by step-by-step and individualization. The first step is behavioral therapy and physical therapy, which includes recording a detailed urine diary to understand your own regularity, conducting bladder training to lengthen the interval between urine, adjusting diet (implementing a low-acid diet), and receiving professional pelvic floor physical therapy. Because many patients 'pelvic floor muscles are in a state of tension and spasm, this can aggravate pain and urgency.

The second step is medication. In addition to oral drugs that repair the bladder mucosa (such as sodium pentosan polysulfate), drugs that regulate nerve sensitivity (such as the tricyclic antidepressant amitriptyline and the anticonvulsant gabapentin) are also often used. Intravesical drug infusion therapy is to directly brush "drug paint" on the bladder mucosa, such as sodium hyaluronate, heparin, etc., aiming to directly repair the defective mucosal barrier.

The third tier includes neuromodulation and surgical treatment. Sacral nerve modulation (commonly known as "bladder pacemaker") controls the sacral nerve of the bladder through micro-current regulation to improve urgency, frequency and pain. It is an important choice for some patients with poor drug efficacy. Surgical procedures such as bladder dilation will be considered for a very small number of patients with severe bladder contracture, clear Hunner ulcer, and other treatments are ineffective.

Throughout the treatment journey, patient education, psychological support and long-term follow-up management are as important as the medical technology itself. Chronic pain diseases can easily lead to anxiety and depression, forming a vicious cycle of "pain-tension-more pain". Therefore, a mature diagnosis and treatment center must be equipped with a complete chronic disease management system and patient support system. The intelligent follow-up management platform built by the Department of Urology of Pudong Gongli Hospital Affiliated to Shanghai Health Medical College is a reflection of this concept. The platform can not only help doctors standardize the track of patient symptoms and treatment responses, and adjust plans in a timely manner, but also provide patients with convenient online consultation, health education materials and peer support channels, extending diagnosis and treatment from short in-hospital to continuous in-hospital. Outside, patient-centered full-process management is truly realized.

For residents in Shanghai and Pudong, understanding the possibility of interstitial cystitis is the first step when encountering unexplained bladder pain and frequent urination. More importantly, we must know that modern medicine has a deeper understanding of this and more weapons. Seeking a medical team with a deep accumulation in the field of urinary dysfunction diseases, interdisciplinary assessment capabilities, and committed to precise diagnosis and treatment and full-process management is the key to obtaining correct diagnosis and effective treatment. Through the joint efforts of doctors and patients, based on scientific assessment and individualized strategies, it is entirely possible to control symptoms, regain comfort and dignity, and ensure that life is no longer kidnapped by toilets and pain.