Present status and advances in bladder pain syndrome: central sensitisation and the urinary microbiome 2022

Question 1

How common is bladder pain syndrome

Answer 1

2-6%

Question 2

What is the association with BPS and the bladder mucosal lining?

Answer 2

• Bladder mucosa lined by protective proteoglycan layer – protein core + glycosaminoglycan (GAG) side chain. Form hydrophobic barrier – prevents permeation of bacteria/proteins/urinary solutes into underlying muscles and nerves. This layer is defunction in some BPS.

Question 3

What lifestyle modification for BPS

Answer 3

Diet - avoid caffeine, alcohol, citrus, spicy foods, chocolate, carbonated drinks
Avoid constipation
Smoking cessation
Avoid UTI - high water intake
Badder training - avoid frequency micturation

Question 4

What oral therapy aims to improve urothelium barrier?

Answer 4

Elmira Pentosan polysulphate

SE retinal pigmanetation

Question 5

What other oral therapies can be offered for BPS

Answer 5

Anticholinergics
Analgesia - amitriptyline (TCA) (SE nausea, blurred vision, skin rash, bowel SE)
Antibiotics

Question 6

What intravesicle treatment can be offered in BPS

Answer 6

Cyistat or iAluRil (hyaluronic acid and chondroitin sulphate )- replace bladder mucosal GAG, may protect underlying sensory nerves

Botox A

Question 7

What other treatments can be offered for BPS

Answer 7

Cystoscopy + hydrodistension
Neuromodulation - Posterior tibial nerve, sacral nerve

Question 8

What is central sensitisation?

Answer 8

increased responsiveness of nociceptive neurons in the CNS to their normal or subthreshold input

Question 9

What other conditions is central sensitisation associated with

Answer 9

.g. fibromyalgia, IBS, chronic fatique sybdrome, vulvodynia, headaches – related to each other.

Question 10

Success rates of amitriptyline in treatment of BPS

Answer 10

45.5–66.0%
Usually at lower doses due to SE

Question 11

How successful is neuromodulation in Tx BPS?

Answer 11

50%