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Phenotyping Might Not Provide Additional Insights for Subtyping IC/BPS By Hunner’s Lesions

Doiron RC, Tolls V, Irvine-Bird K, Kelly KL, Nickel JC. Clinical phenotyping does not differentiate Hunner’s lesion subtype of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS): A relook at the role of cystoscopy. J Urol. 2016 Apr 23. pii: S0022-5347(16)30286-5. doi: 10.1016/j.juro.2016.04.067. [Epub ahead of print]
There is some hope that looking carefully at a particular patient’s phenotype–that is, various traits and characteristics that can be observed and recorded–might be helpful in the diagnosis or treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). A specific phenotyping system known as UPOINT (Urinary, Psychosocial, Organ-specific, Infection, Neurologic or non-bladder, and Tenderness of pelvic floor) is available to classify IC/BPS patients in such a manner. In one previous study, about 50% of patients had clinically significant improvement in symptoms when managed using UPOINT to develop an individualized treatment approach, regardless of how complex or severe the symptoms were. In this more recent study, investigators determined whether UPOINT could help clinicians distinguish between IC/BPS with and without Hunner’s lesions. Currently, a cystoscopy is required to diagnose IC/BPS with Hunner’s lesion. A total of 469 previous IC/BPS patient cases were reviewed and analyzed. Unfortunately, the UPOINT system did not reveal a distinct bladder phenotype associated with Hunner’s lesion IC/BPS as compared to non-Hunner’s lesion IC/BPS, although they did find worse bladder-specific symptoms in patients with Hunner’s lesions. Based on this experience, the investigators suggested patients diagnosed with IC/BPS undergo cystoscopy with local anesthesia to determine whether Hunner’s lesions are present.