Hunner lesion versus non-Hunner lesion interstitial cystitis/bladder pain syndrome.

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Kristene E Whitmore, Magnus Fall, Atsushi Sengiku, Hikaru Tomoe, Yr Logadottir, Young Ho Kim

Author Information

Kristene E Whitmore: Division of Female Pelvic Medicine and Reconstructive Surgery and Urology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Magnus Fall: Department of Urology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Atsushi Sengiku: Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan.
Hikaru Tomoe: Department of Urology and Pelvic Reconstructive Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Yr Logadottir: Department of Urology, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Young Ho Kim: Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.

PMID: 31144757 DOI: 10.1111/iju.13971

BACKGROUND: Global consensus on the standardization of terminology for interstitial cystitis/bladder pain syndrome is lacking and is in the formative stages. The Workshop on Hunner lesion versus non-Hunner lesion at the 2018 International Consultation on Interstitial Cystitis Japan discussed prevalence, performance and outcome of endoscopy, the role of histopathology, and markers.
METHODS: A panel of experts reviewed the literature regarding Hunner lesion vs. non-Hunner lesion interstitial cystitis/bladder pain syndrome.
RESULTS: The prevalence of Hunner lesion has been reported to be 5-57%. Older age and smaller anatomic bladder capacity were associated with Hunner lesions. Cystoscopy using local anesthesia is not adequate in diagnosing interstitial cystitis but is needed to rule out confusable diseases. Cystoscopy with hydrodistention and redistention of the bladder is considered standard. A Hunner lesion is visualized as a quite typical inflammatory reaction: a reddened mucosal area with small vessels radiating towards a central scar, splitting at distension, usually associated with a waterfall bleeding pattern. Biopsies from the inflamed area show inflammatory infiltrates, granulation tissue, detrusor mastocytosis, and fibrin deposits. Ablation of Hunner lesions includes transurethral resection of lesions, fulguration, laser ablation, and cortical steroid injections. Mast cell density is a somewhat controversial matter, described differently in different studies: marked increase in Hunner lesion vs. non-Hunner lesion in the majority of studies, no difference in a few. Nitric oxide appears to be a definitive marker in distinguishing Hunner lesion vs. non-Hunner lesion disease. Macrophage migration inhibitory factor is elevated in Hunner lesion patients. Increased level of urinary proinflammatory genes expression has also been found in Hunner lesion subjects.
CONCLUSIONS: Hunner lesion patients are clinically and pathologically distinct from non-Hunner lesion bladder pain syndrome patients.

Hunner lesion Hunner lesion interstitial cystitis bladder pain syndrome (BPS, PBS) interstitial cystitis non-Hunner lesion interstitial cystitis

Biomarkers

Cystitis, Interstitial

Cystoscopy

Humans

Pelvic Pain

Recurrence

Urinary Bladder

Biomarkers

Journal Article Review

Small Fiber Polyneuropathy in Hunner Lesion and Non-Hunner Lesion Interstitial Cystitis/Bladder Pain Syndrome.Editorial Comment from Dr Hanno to Hunner lesion versus non-hunner lesion interstitial cystitis/bladder pain syndrome.Editorial Comment from Dr Homma to Hunner lesion versus non-hunner lesion interstitial cystitis/bladder pain syndrome.Histopathological characteristics of interstitial cystitis/bladder pain syndrome without Hunner lesion.The bacterial microbiota of Hunner lesion interstitial cystitis/bladder pain syndrome.Hunner Lesion Phenotype in Interstitial Cystitis/Bladder Pain Syndrome: A Systematic Review and Meta-Analysis.Hydrodistention does not alter bladder gene expression profiles in patients with non-Hunner lesion interstitial cystitis/bladder pain syndrome.Evidence for Early Cyclosporine Treatment for Hunner Lesion Interstitial Cystitis.The Efficacy of Micro-Radiofrequency Therapy for Treating Non-Hunner Lesion Interstitial Cystitis/Bladder Pain Syndrome: A Retrospective Cohort Study.Downregulation of WNT11 is associated with bladder tissue fibrosis in patients with interstitial cystitis/bladder pain syndrome without Hunner lesion.

Possible Association between Bladder Wall Morphological Changes on Computed Tomography and Bladder-Centered Interstitial Cystitis/Bladder Pain Syndrome.Evaluating symptom severity and urinary cytokine levels in interstitial cystitis/bladder pain syndrome patients, with and without Hunner's lesions.Usefulness of Urinary Biomarkers for Assessing Bladder Condition and Histopathology in Patients with Interstitial Cystitis/Bladder Pain Syndrome.Immune cell profiles of patients with interstitial cystitis/bladder pain syndrome.Efficacy and safety of intravesical instillation of KRP-116D (50% dimethyl sulfoxide solution) for interstitial cystitis/bladder pain syndrome in Japanese patients: A multicenter, randomized, double-blind, placebo-controlled, clinical study.Perioperative Safety of Bladder Hydrodistention in Patients on Antithrombotic Therapy.Immunomodulation-A Molecular Solution to Treating Patients with Severe Bladder Pain Syndrome?Advancing Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) Diagnosis: A Comparative Analysis of Machine Learning Methodologies.Intravesical Interferon Therapy vs Hyaluronic Acid for Pain Among Female Individuals With Interstitial Cystitis: A Randomized Clinical Trial.The O'Leary-Sant Interstitial Cystitis Symptom Index is a clinically useful indicator of treatment outcome in patients with interstitial cystitis/bladder pain syndrome with Hunner lesions: A post hoc analysis of the Japanese phase III trial of KRP-116D, 50% dimethyl sulfoxide solution.

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