In this unique analysis, investigators asked whether symptom fluctuations in women and men with urological chronic pelvic pain syndrome (CPPS) had any influence on how patients’ symptoms are categorized. To test this, they assessed symptoms every other week in 424 individuals with CPPS over the course of one year. In particular, they highlighted the influence of early symptom regression, or a tendency for symptoms to improve in the early part of the examination period. They found that over time, about 25-38% of patients were classified as having improved symptoms, while 5-6% were classified as having worse symptoms. However, after excluding the first few weeks of the examination period, the number of patients classified as improved fell to 15-25%, while the number of patients classified as worsening was slightly higher at 6-9%. Researchers said these findings illustrate the variability of symptoms in CPPS, and in particular, that patients tended to have worse symptoms at enrollment. Thus, they suggested future treatment studies in CPPS might need to include a “run-in” period to account for this phenomenon of early symptom regression.

Biomarkers for urinary disorders are a hot topic in terms of their potential to aid with diagnosis and to serve as a target for treatment. In particular, nerve growth factor (NGF) is a biomarker that in several recent studies has been associated with overactive bladder and interstitial cystitis/bladder pain syndrome (IC/BPS) in terms of diagnosis. However, results of these studies are sometimes inconsistent in terms of the link between NGF and IC/BPS, so this group of investigators conducted a meta-analysis (study of studies) pooling together results from all published original studies they could find on this topic. They included 10 studies involving 295 patients and 290 controls. Together, the findings confirmed that the level of NGF in the urine is elevated in IC/BPS patients. While further research on the link between NGF and IC/BPS is needed to better characterize its significance, this is believed to be the first comprehensive analysis of existing research on this topic.

Experts from around the world have collaborated to produce a first-of-its-kind guide that will help everyone speak the same language when diagnosing, treating, and studying pelvic pain syndromes. The first-ever International Continence Society (ICS) Standard for Terminology in Chronic Pelvic Pain Syndromes will likely not only improve understanding of these diseases, but also help clinicians and researchers alike as they provide patient care and conduct studies of promising new therapies. The guide covers many aspects of pelvic pain syndromes and makes specific reference to interstitial cystitis/bladder pain syndrome (IC/BPS). Of note, the experts are careful to explain the difference between conditions, diseases, and syndromes. They note that IC/BPS is a “syndrome,” defined as a situation where a group of symptoms and signs that occur together, collectively indicating a disease despite no obvious disease pathology (i.e. no clear causes of disease identified in bodily fluids, tissues, or organs). They specifically define IC/BPS as “persistent or recurrent chronic pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as an urgent need to void or urinary frequency.” The authors hope their guide will help advance the field through better classification of patients, better clinical trials, and more effective drugs. However, they caution that having clear definitions of these diseases and syndromes is just a starting point for evaluation of specific patients, which needs to be individualized based on the patient’s unique perception of pain, social issues, and other factors.

One reason why interstitial cystitis/bladder pain syndrome (IC/BPS) is difficult to diagnose and treat is a lack of biochemical markers (i.e., substances found in tissues or fluids such as blood or urine that are universally accepted as an indication of the disorder. In an effort to help change that, researchers in this study evaluated urine specimens from female IC/BPS patients with a technique called mass spectrometry-based global metabolite profiling. The goal was to identify one or more metabolites–substances involved in growth, reproduction, development and other related processes–capable of distinguishing IC/BPS patients from non-IC/BPS patients. They did find one metabolite, known as Etio-S (etiocholan-3α-ol-17-one sulfate), that was able to detect IC/BPS more than 90% of the time. Moreover, there was a correlation between levels of Etio-S found in the urine and IC/BPS symptoms, pelvic pain, and number of painful body sites. Studying how metabolites work, a science known as metabolomics, is just one approach to identifying biomarkers for IC/BPS. In other recent studies, investigators have found potential markers using brain imaging and analysis of inflammatory markers, among other techniques. Investigators hope that by combining these approaches, they might be able to better define the early changes associated with IC/BPS, which might lead to earlier intervention to treat the disorder.

Investigators in this study sought to determine whether specific diagnostic tests of the bladder could be used to help diagnose patients with urinary symptoms, and in particular, determine whether the underlying cause is interstitial cystitis/bladder pain syndrome (IC/BPS) or severe overactive bladder (OAB). To test this, they conducted a study of 52 female outpatients with a clear diagnosis of either IC/BPS (24 patients) or severe OAB (28 patients). In particular, they looked at bladder capacity measurements using a diagnostic procedure called cystometry, and found that women with OAB had significantly higher bladder volumes than women with IC/BPS at various time points (e.g., time of normal desire, strong desire, and maximal capacity). Other urodynamic studies also pointed out key differences in measurements between the two groups that could potentially help specialists distinguish between IC/BPS and OAB.

In this practical review article, the authors state that treatment for most patients with interstitial cystitis/bladder pain syndrome (IC/BPS) can achieve significant symptom relief with many simple and effective treatments that are available. However, they acknowledge that diagnosing IC/BPS and formulating a treatment approach can be daunting for practitioners, and recommend using office-based algorithms and guidelines to guide treatment choices and for discussions with patients. To help facilitate patient-directed care, the authors outline current standards for diagnosis and testing, first- and second-line therapies, and follow-up care. Encouragingly, they say that most clinicians should be able to adequately care for patients with IC/BPS, and that most patients will not need referral to a specialist. However, part of the challenge of treating IC/BPS is understanding that each patient will need individually tailored therapy, and will need to learn what works for them in terms of effective care. Ultimately, they say that the most effective strategy, and the one that will lead to the greatest patient satisfaction, is helping patients take charge of the management of their disease.

This study elucidates risk factors for relapse and remission of vulvodynia, or chronic pain in the vulvar area. Results are based on data from women with vulvodynia in the University of Michigan’s large and comprehensive Woman to Woman Health Study. The investigators identified 441 women in the study who screened positive for vulvodynia, and of that group, 239 of the women completed 4 more surveys. Based on this data, investigators were able to determine that about 50% of the women with vulvodynia eventually went into remission and did not relapse. Another 40% of the women initially experienced remission at some point, but unfortunately relapsed within 6-30 months. Only about 10% of the women had persistent vulvodynia at each screening (i.e., no remissions). Interestingly, investigators found that key factors associated with relapse included provoked pain at the first screening, or a diagnosis of interstitial cystitis at the first screening. Factors associated with persistence included more severe intercourse-related symptoms, pain with oral sex, or pain with partner touch. The key take-away message is vulvodynia usually occurs in episodes; in other words, remission of vulvodynia symptoms is the common scenario, while persistent symptoms with no remission is the exception, not the rule.