Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease characterized by suprapubic pain and lower urinary tract symptoms. Perhaps because of the heterogeneous nature of this disease and its multifactorial etiology, clinical trials in allinclusive populations of IC/BPS patients without phenotyping in the last decade have mainly failed to discover new therapeutic modalities of IC/BPS. Thus, phenotyping IC/BPS, aimed at identifying bladder-centric and/or bladder-beyond pathologies, including cystoscopic observation of Hunner or non-Hunner lesions of the bladder mucosa, is particularly important for the future of IC/BPS management. Based on recent discussions at international conferences, including the International Consultation on IC, Japan, it has been proposed that Hunner-lesion IC should be separated from other non-Hunner IC/BPS because of its distinct inflammatory profiles and epithelial denudation compared with non-Hunner IC/BPS. However, there are still no standard criteria for the diagnosis of Hunner lesions other than typical lesions, while conventional cystoscopic observations may miss atypical or small Hunner lesions. Furthermore, diagnosis of the bladder-centric phenotype of IC/BPS requires confirmation that identified mucosal lesions are truly a cause of bladder pain in IC/BPS patients. This review article discusses the current status of IC/BPS pathophysiology and diagnosis, as well as future directions of the proper diagnosis of bladder-centric IC/BPS, in which pathophysiological mechanisms other than those in inflammatory pathways, such as angiogenic and immunogenic abnormalities, could also be involved in both Hunner-lesion IC and non-Hunner IC/BPS. It is hoped that this new paradigm in the pathophysiological evaluation and diagnosis of IC/BPS could lead to pathology-based phenotyping and new treatments for this heterogeneous disease.

中文翻译：

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间质性膀胱炎/膀胱疼痛综合征的当前认识和未来展望。

间质性膀胱炎/膀胱疼痛综合征（IC/BPS）是一种以耻骨上疼痛和下尿路症状为特征的慢性疾病。也许由于该疾病的异质性及其多因素病因学，过去十年在未进行表型分析的所有 IC/BPS 患者群体中进行的临床试验主要未能发现新的 IC/BPS 治疗方式。因此，IC/BPS 表型分析旨在识别膀胱中心和/或膀胱以外的病理，包括膀胱粘膜 Hunner 或非 Hunner 病变的膀胱镜观察，对于 IC/BPS 管理的未来尤为重要。根据最近在国际会议上的讨论，包括日本 IC 国际磋商会，有人建议将 Hunner 病变 IC 与其他非 Hunner IC/BPS 分开，因为与非 Hunner 病变 IC/BPS 相比，其具有独特的炎症特征和上皮剥脱。亨纳 IC/BPS。然而，除了典型病变之外，目前还没有诊断Hunner病变的标准标准，而传统的膀胱镜观察可能会漏掉非典型或小的Hunner病变。此外，IC/BPS 以膀胱为中心的表型的诊断需要确认已识别的粘膜病变确实是 IC/BPS 患者膀胱疼痛的原因。本文讨论了 IC/BPS 病理生理学和诊断的现状，以及以膀胱为中心的 IC/BPS 的正确诊断的未来方向，其中炎症途径以外的病理生理机制，如血管生成和免疫原性异常，也可能涉及Hunner 病变IC 和非Hunner IC/BPS。希望这种 IC/BPS 病理生理学评估和诊断的新范式能够带来基于病理学的表型分析和针对这种异质性疾病的新治疗方法。