間質性膀胱炎（ハンナ型）

OBJECTIVES: To evaluate the potential role of the pre-procedural gamma-glutamyltransferase-to-lymphocyte ratio (GLR) as an adjunctive biomarker for differentiating Hunner-type interstitial cystitis (HIC) from bladder pain syndrome (BPS). METHODS: Consecutive patients who underwent cystoscopic evaluation with hydrodistension for suspected interstitial cystitis/bladder pain syndrome between April 2016 and September 2025 were retrospectively analyzed. HIC and BPS were diagnosed by expert adjudication based on cystoscopic, clinical, and histopathological findings. GLR was calculated as serum gamma-glutamyltransferase divided by peripheral lymphocyte count. Diagnostic performance was assessed using receiver operating characteristic analysis, and associations with HIC were evaluated using logistic regression. RESULTS: Among 106 patients, 62 had HIC and 44 had BPS. GLR was significantly higher in HIC than BPS (21.4 ± 14.7 vs. 14.2 ± 15.2, p = 0.016) and correlated with total histological activity score (ρ = 0.606, p < 0.001). GLR showed an AUC of 0.759, while GGT showed similar discrimination (AUC 0.776; p = 0.592 vs. GLR). Adding GLR to a clinical model did not improve discrimination (AUC 0.948 vs. 0.949; p = 0.879). In the covariate-adjusted multivariable analysis, GLR remained associated with HIC (odds ratio 1.04, 95% confidence interval 1.01-1.10, p = 0.032). CONCLUSIONS: Pre-procedural GLR may serve as a practical blood-based adjunct reflecting bladder-inflammatory histopathology and supporting early phenotyping across the IC/BPS spectrum, although prospective external validation is required.

PURPOSE: Treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) often lacks durable efficacy. Intravesical platelet-rich plasma (PRP) achieves > 50% success rates, but some patients remain refractory. This study evaluated the outcome of combined triamcinolone and PRP in patients with suboptimal response to prior PRP therapy. METHODS: Sixty-two patients with IC/BPS and inadequate response (global response assessment [GRA] <2) to previous PRP injections at least 3 months earlier were included. All patients received four monthly intravesical injections of PRP combined with 40 mg triamcinolone. Changes in symptom scores and uroflowmetry parameters were assessed from baseline to 3 and 6 months after treatment and compared with prior post-PRP treatment outcomes. RESULTS: The cohort included 15 patients with Hunner's IC (HIC) and 47 with non-Hunner's IC (NHIC). After treatment, symptom scores and bladder pain improved significantly, with 33 patients (53.2%) achieving GRA ≥2 at 3 months and 38 (61.3%) at 6 months after completion of combined treatment. Compared with prior PRP post-treatment outcome, combined therapy resulted in greater symptom improvement. Patients with NHIC and HIC demonstrated similar treatment outcome and reductions in bladder pain. Within the NHIC subgroup, patients with different cystoscopic hydrodistention findings at baseline showed similar symptomatic improvement with combined therapy. However, patients with a higher baseline bladder pain score (visual analog score ≥5) had a less favorable GRA at 3 months. CONCLUSION: Combined PRP and triamcinolone intravesical injections achieved a satisfactory treatment outcome in 61.3% of patients with IC/BPS who were refractory to previous PRP treatment, suggesting a potential role for adjunctive steroid therapy targeting inflammation.

BACKGROUND: Chronic pelvic pain (CPP) is increasingly recognized as a disorder of altered central pain processing, providing a strong rationale for non-invasive brain stimulation (NIBS) as a therapeutic approach. However, use of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) for CPP remains uncertain. This systematic review aimed to evaluate the evidence for NIBS in CPP. METHODS: A comprehensive search of PubMed, Web of Science, Ovid MEDLINE, Embase, Scopus, and Cochrane CENTRAL was conducted till July 2026. Studies evaluating tDCS or rTMS in adults with CPP were included. Cochrane RoB-2 and ROBINS-I were used to assess methodological quality. Owing to a low number of studies, substantial clinical and methodological heterogeneity, a structured narrative approach was used. RESULTS: Fifteen studies involving 295 participants, of whom 264 completed the respective studies, met the inclusion criteria, including nine tDCS and six rTMS studies. Inter-rater agreement for data extraction was almost perfect (Cohen's kappa = 0.878). Considerable heterogeneity was observed across clinical conditions, protocols, comparator interventions, outcome measures, and follow-up durations. Most randomized controlled trials (RCT) were rated at high or some risk of bias. Across studies, tDCS demonstrated favorable effects in some conditions, although findings were inconsistent and benefits beyond the treatment period were not consistently demonstrated. Evidence for rTMS was more limited and heterogeneous. CONCLUSIONS: Current evidence is insufficient to support NIBS for routine CPP care because of methodological limitations, small samples, and substantial heterogeneity in stimulation protocols and populations. Well-designed RCT using standardized intervention protocols and outcome measures are needed. PROSPERO ID: CRD420251058830.

Fibromyalgia (FM), a chronic centralized pain syndrome, has been associated with lower urinary tract pain and lower urinary tract symptoms (LUTS) in women, but quantitative evidence remains limited. We searched PubMed/MEDLINE, Embase, Web of Science Core Collection, and CINAHL from January 1990 to December 2025 for observational studies. Fourteen studies involving 17,139 women were included. Random-effects meta-analysis showed increased odds of lower urinary tract pain (OR = 2.92, 95% CI: 1.41-6.06) and lower urinary tract symptoms (OR = 2.83, 95% CI: 1.98-4.03), but the certainty of evidence was very low. For lower urinary tract pain, the association was concentrated in studies using validated interstitial cystitis/painful bladder syndrome definitions; the clinician-based FM subgroup yielded a more conservative estimate (OR = 1.45, 95% CI: 1.15-1.83), whereas the larger self-reported estimate (OR = 5.84, 95% CI: 2.16-15.79) may have inflated the overall pooled estimate. The overall LUTS association appeared to be driven predominantly by urgency-related storage symptoms, including overactive bladder (OR = 2.65, 95% CI: 1.88-3.74) and urge urinary incontinence (OR = 2.95, 95% CI: 1.05-8.28); no significant association was found for stress urinary incontinence (OR = 1.00, 95% CI: 0.63-1.59). Heterogeneity was substantial for both primary outcomes (I 2 = 79.07% and 79.05%). Outlier exclusion reduced the lower urinary tract pain OR to 1.66, while LUTS heterogeneity remained substantial (I 2 = 73.50%). These findings are preliminary and hypothesis-generating and require confirmation in prospective studies with standardized outcome assessment.

BACKGROUND/OBJECTIVES: Patients increasingly use large language model (LLM) interfaces for health information, but their safety and quality for public questions about interstitial cystitis/bladder pain syndrome (IC/BPS) remain uncertain. This study evaluated the safety, accuracy, empathic communication, information quality, reliability, and readability of five publicly accessible LLM interfaces. METHODS: In this CHART-guided cross-sectional comparative study, 58 public-facing IC/BPS questions were submitted once, in English, to ChatGPT, Gemini, Microsoft Copilot, DeepSeek, and Doubao using a standardized single-turn, zero-shot protocol. Three blinded senior urologists independently assessed safety, accuracy, empathic communication, DISCERN, EQIP, JAMA benchmark criteria, and Global Quality Score. Six readability indices were calculated. RESULTS: Inter-rater agreement was significant for all manually assessed metrics. Fleiss' kappa for safety was 0.822, and ICC(2,1) values for other rater-assessed metrics ranged from 0.761 to 0.848. Unsafe responses occurred in all interfaces, ranging from 5.2% for ChatGPT to 8.6% for DeepSeek and Doubao, without a significant between-interface difference (Cochran Q = 1.000, p = 0.910). Accuracy and empathic communication differed significantly across interfaces (both p < 0.001). ChatGPT had the highest median accuracy score, whereas DeepSeek had the highest empathic communication score. Information-quality and reliability scores also differed significantly (all p < 0.001); ChatGPT achieved higher DISCERN, EQIP, and GQS scores, while Gemini achieved higher JAMA scores. Readability differed significantly across interfaces, but none met predefined patient-facing readability benchmarks. CONCLUSION: Publicly accessible LLM interfaces showed domain-specific differences when answering IC/BPS-related public questions. Unsafe responses were uncommon but present in all interfaces, and no interface consistently outperformed the others. LLM interfaces may support general IC/BPS education and question preparation but should not replace clinician-led evaluation or individualized medical advice.