間質性膀胱炎（ハンナ型）

INTRODUCTION AND HYPOTHESIS: Female bladder pain syndrome (FBPS) is a chronic condition characterized by bladder pain, urgency, and frequency that significantly impacts quality of life. Management includes nonsurgical and procedural therapies. Our objective was to evaluate the time from FBPS diagnosis to procedural intervention and identify predictors of intervention. METHODS: A retrospective cohort study identified women with FBPS from 2013 to 2023 using ICD-10 codes at a single tertiary care center in the United States. Interventions were categorized per the 2022 AUA guideline, including behavioral/non-pharmacologic therapies, medications, intravesical instillations, procedures, and major surgeries. Kaplan-Meier analysis estimated time to first procedural intervention, and Cox proportional hazards models identified factors associated with intervention. RESULTS: Among 149 patients, 111 (74.5%) underwent at least one bladder-directed procedural intervention, with a median time to first procedure of 1.08 years. The most common intervention was cystoscopy with hydrodistension (N = 83, 55.7%), followed by intravesical instillations (53, 35.6%). Image-guided nerve blocks (11, 7.4%) and onabotulinumtoxinA injections (5, 3.4%) were less frequent. Among those undergoing procedures, 84 (75.7%) required repeat interventions. On multivariable analysis, stress urinary incontinence (HR 2.02, p = 0.05) and tobacco use (HR 1.86, p = 0.03) were associated with increased hazard, while partnered relationship status was associated with reduced hazard (HR 0.62, p = 0.05). CONCLUSION: Most patients with FBPS underwent procedural intervention by 1.08 years from diagnosis, most commonly cystoscopy with hydrodistension. Stress urinary incontinence and tobacco use were significant predictors. These findings highlight the importance of individualized management and early identification of patients likely to require procedural therapy.

Hunner type interstitial cystitis is a chronic inflammatory bladder disorder characterized by pain and severe lower urinary tract symptoms. Using single-cell RNA sequencing of Hunner lesions, non-Hunner lesions, and control bladder tissues, we characterized cellular states and intercellular communication within the bladder microenvironment. We identified a neuregulin enriched fibroblast population that was preferentially expanded in Hunner lesions and exhibited enhanced signaling toward basal epithelial cells through NRG and WNT pathways. In contrast, myofibroblast states were more prominent in non-Hunner lesions. Epithelial cells showed increased heterogeneity and differentiation toward inflammatory umbrella cell states, consistent with tissue remodeling. These findings define stromal and epithelial alterations across the diseased bladder and highlight fibroblast epithelial communication as a potential contributor to chronic inflammation and tissue remodeling in Hunner type interstitial cystitis.

Interstitial cystitis (IC), also known as bladder pain syndrome (BPS), is a chronic and devastating urologic disease. Its characteristics include the damage to the barrier function of bladder mucosa, inflammation related to nerve activity and chronic pelvic pain. Traditional treatments often only alleviate symptoms and cannot fundamentally treat this disease. This has inspired to seek new opportunities and strategies to use biomaterials and nanomedicine to reverse tissue damage and pain in patients with this disease. In this review, we comprehensively summarized the latest advances in innovative strategies for bladder mucosal repair and inflammation modulation. This includes glycosaminoglycan mimetics, nanomaterial-based drug delivery systems, stem cells and exosome-based nanomedicine, platelet-rich plasma, and other emerging nanomaterial-related therapeutic approaches. Moreover, we also explored their potential mechanisms of action, valuable results from preclinical and clinical studies, current challenges, and future possibilities for clinical applications. This review may promote the prospect of targeted multifunctional strategies to improve the clinical treatment of IC/BPS.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition whose diagnosis relies primarily on a structured process of exclusion. Defined as chronic pelvic pain, pressure, or discomfort perceived in relation to the bladder, accompanied by at least one urinary symptom, IC/BPS encompasses significant clinical and pathophysiological heterogeneity. A thorough medical history, targeted physical examination, and validated questionnaires such as the O'Leary-Sant score (ICSI/ICPI) form the foundation of initial evaluation. Patient phenotyping - distinguishing in particular the bladder-centric from the sensitization phenotype - is essential to guide both diagnostic and therapeutic strategies. Complementary investigations include a voiding diary, urine culture, imaging (ultrasound as first-line, CT scan and MRI as second-line modalities), and cystoscopy (preferably with hydrodistension under general anesthesia), which allows identification of Hunner's lesions, measurement of anatomical bladder capacity, and targeted biopsies. Urodynamic testing is reserved for cases of diagnostic uncertainty or associated voiding dysfunction. These recommendations aim to standardize the diagnostic approach in order to optimize individualized management in patients suffering from IC/BPS.

PURPOSE: To develop and validate a pragmatic histopathological scoring system for interstitial cystitis/bladder pain syndrome (IC/BPS) that distinguishes Hunner-type interstitial cystitis (HIC) from bladder pain syndrome (BPS) and inflammatory non-HIC chronic cystitis mimicking Hunner lesions ("other cystitis"). METHODS: Bladder biopsies from 96 patients were analyzed: HIC (n = 32), BPS (n = 42), and other cystitis (n = 22; bacillus Calmette-Guérin-related, follicular, and chronic bacterial cystitis). Four pathologists (A-D; A as index/model observer) independently scored hematoxylin-eosin sections using five histopathological features (inflammation, plasma cell infiltration, eosinophil infiltration, tertiary lymphoid structures, urothelial denudation; total 0-8). ROC curves were generated for HIC vs. BPS and HIC vs. other cystitis. Youden index-derived thresholds were compared across observers to select simple integer cutoffs and define an operational three-tier classification (0-2: BPS, 3-4: indeterminate, 5-8: HIC). Diagnostic performance was assessed using AUC and contingency-table metrics. Inter-observer agreement for the three-tier classification was evaluated using Fleiss' kappa. RESULTS: HIC vs. BPS discrimination was excellent across pathologists (AUC 0.966-0.991; pooled AUC 0.983). HIC vs. other cystitis discrimination was moderate-to-good (AUC 0.723-0.808; pooled AUC 0.738). Overall agreement for the three-tier classification was 60.4% with Fleiss' κ = 0.657; agreement was highest for BPS and modest for other cystitis. CONCLUSIONS: This hematoxylin-eosin-based scoring system enables standardized IC/BPS phenotyping, robustly separating HIC from BPS and providing a structured framework for inflammatory overlap cases, with reproducible performance across international pathologists.