Interstitial cystitis: pathogenesis, diagnostics and treatment (part 2)
This review summarizes the diagnostics and treatment of the main factors of pathogenesis of interstitial cystitis (IC)/painful bladder syndrome. The diagnostics of interstitial cystitis/painful bladder syndrome is still complicated to a certain extent, since such symptoms of IC as pollakiuria and urgency are also typical for hyperactive urinary bladder, and pain upon bladder filling is also typical for bacterial cystitis. The treatment of the damaged or incompetent glycosaminoglycan (GAG) layer of the urothelium includes cystoscopy combined with hydrodistention of the bladder followed by intracystic and oral GAG-replacement therapy. Abacterial inflammation of the interstitium followed by activation of mast cells is diagnosed by determining the level of cytokines in urine and by pathohistological examination of the urothelium; the treatment includes intracystic instillations and irrigation of the bladder with a warm solution of anesthetics and glucocorticosteroids. The sensibilization of the peripheral nervous system due to the increase in the number of nociceptors is defined by determining the level of cytokines in urine and by immunohistochemical examination of the urothelium. The treatment includes intracystic instillations and irrigation of the bladder with a warm solution of anesthetics and glucocorticosteroids, and also injections of botulinic neuropeptide into the Lyeto triangle. The diagnostics of the myofascial pain syndrome (spasticity) of the striated muscles of the pelvic floor and the perineum is based on the measurement of tonus of the pelvic floor muscles; treatment is based on the injections of anesthetics, glucocorticosteroids and botulinic neuropeptide into the “trigger” regions, as well as their massage.