Mesane Ağrısı Sendromu / İnterstisyel Sistit
Özet
Mesane Ağrısı Sendromu/İnterstisyel Sistit (MAS/İS), kronik pelvik ağrı sendromları içerisinde tanısal güçlükleri ve heterojen klinik özellikleri ile öne çıkan kompleks bir hastalıktır. Tanım ve terminolojideki değişikliklere rağmen günümüzde Uluslararası Kontinans Derneği, MAS/İS’i idrar yolu enfeksiyonu veya belirgin patoloji olmaksızın, mesanenin dolmasıyla ortaya çıkan suprapubik ağrı ve eşlik eden işeme semptomları ile karakterize bir tablo olarak tanımlamaktadır. Hastalığın etiyopatogenezi tam olarak açıklığa kavuşmamış olup; ürotelyal bariyer disfonksiyonu, otoimmün mekanizmalar, mast hücre aktivasyonu, antiproliferatif faktör üretimi ve nörojenik mekanizmalar gibi hipotezler öne sürülmektedir. Tanı süreci ayrıntılı öykü, semptom skorlamaları, fizik muayene, laboratuvar tetkikleri ve sistoskopi ile multidisipliner bir yaklaşımla gerçekleştirilmelidir. Tedavide temel amaç semptom kontrolü ve yaşam kalitesinin artırılmasıdır. Bu doğrultuda hasta bilgilendirmesi ve davranışsal düzenlemeler ilk basamağı oluştururken; farmakolojik tedaviler (ör. pentosan polisülfat, amitriptilin), intravezikal ajanlar, botulinum toksin uygulamaları ve nöromodülasyon daha ileri seçeneklerdir. Dirençli olgularda cerrahi tedavi gündeme gelebilmektedir. Güncel kılavuzlar, fenotip temelli ve bireyselleştirilmiş tedavi yaklaşımlarının önemini vurgulamaktadır.
Referanslar
Hanno, P, Cervigni M, Choo MS et al. Interstitial Cystitis /Bladder Pain Syndrome. In: Cardozo L, Rovner E, Wagg A, Weın A, Abrams P eds. Incontinence. 7th edn. ICUD ICS 2023. 1849-1940. ISBN: 978-0-9569607-4-0.
Castro-Diaz D, Fall M. Bladder Pain Syndrome/Interstitial Cystitis: A Large but Heterogeneous Field in Functional Urology. In Heesakkers J, Chapple C, De Ridder D, Farag F eds. Practical Functional Urology. Springer: ISBN 978-3-319-25430-2 (eBook)
Yamada Y, Nomiya A, Niimi A, et al. A survey on clinical practice of interstitial cystitis in japan. Transl Androl Urol 2015, Oct;4(5):486-90.
Parsons CL, Tatsis V. Prevalence of interstitial cystitis in young women. Urology 2004, Nov;64(5):866-70.
Nickel JC, Stephens A, Landis JR, et al. Assessment of the lower urinary tract microbiota during symptom flare in women with urologic chronic pelvic pain syndrome: A MAPP network study. J Urol 2016, Feb;195(2):356-62.
Zhang QH, Shen XC, Zhou ZS, et al. Decreased nanobacteria levels and symptoms of nano-bacteria-associated interstitial cystitis/painful bladder syndrome after tetracycline treatment. Int Urogynecol J 2010,Jan;21(1):103-9.
Aydogan TB, Gurpinar O, Koseoglu Eser O, et al. A new look at the etiology of interstitial cystitis/bladder pain syndrome: extraordinary cultivations. 2019 Nov;51(11):1961-1967.
Gamper M, Regauer S, Welter J, et al. Are mast cells still good biomarkers for bladder pain syndrome/ interstitial cystitis? J Urol 2015, Jan 14;193(6):1994-2000.
Grundy L, Caldwell A, Lumsden A, et al. Experimentally induced bladder permeability evokes bladder afferent hypersensitivity in the absence of inflammation. Front Neurosci 2020;14:590871.
Anderström C.R.; Fall M.; Johansson S.L. Scanning electron microscopic findings in interstitial cystitis. Br. J. Urol. 1989, 63, 270–275.
Van de Merwe JP. Interstitial cystitis and systemic autoimmune diseases. Nat Clin Pract Urol 2007, Sep;4(9):484-91.
Peeker R, Enerback L, Fall M, et al. Recruitment, distribution and phenotypes of mast cells in interstitial cystitis. J Urol 2000, Mar;163(3):1009-15.
Keay S, Reeder JE, Koch K, et al. Prospective evaluation of candidate urine and cell markers in patients with interstitial cystitis enrolled in a randomized clinical trial of bacillus calmette guerin (BCG). World J Urol 2007, Oct;25(5):499-504.
Ward EP, Bartolone SN, Chancellor MB, et al. Proteomic analysis of bladder biopsies from interstitial cystitis/bladder pain syndrome patients with and without hunner’s lesions reveals differences in expression of inflammatory and structural proteins. BMC Urol 2020, Nov 7;20(1):180.
Esen B, Obaid K, Suer E et al. Turkish Versions of the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) Linguistic and Psychometric Validation. ICS 2019, Gothenburg.
Tarcan T, Mangır M, Özgür MÖ et al. OAB-V8 Aşırı Aktif Mesane Sorgulama Formu Validasyon Çalışması. Üroloji Bülteni (2012), 21, 113-116.
Engeler D, Baranowski AP, Berghmans B, et al. EAU Guidelines on Chronic Pelvic Pain. 2024; https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on Chronic-Pelvic-Pain-2024.pdf
McKernan LC, Walsh CG, Reynolds WS, et al. Psychosocial co-morbidities in interstitial cystitis/bladder pain syndrome (IC/BPS): A systematic review. Neurourol Urodyn 2018;37(3):926-41.
Nordling J, Anjum FH, Bade JJ, et.al. Primary evaluation of patients suspected of having interstitial cystitis (IC). Eur Urol 2004, 45(5):662-669.
Koçak T, Acar Ö, Tarhan F, et al. Mesane Ağrısı Sendromu (İnterstisyel Sistit) Uzlaşı Metni, İstanbul 2019, ISBN: 978-605-7905-15-4
Chiang G, Patra P, Letourneau R, et al. Pentosanpolysulfate inhibits mast cell histamine secretion and intracellular calcium ion levels: An alternative explanation of its beneficial effect in interstitial cystitis. J Urol 2000, Dec;164(6):2119-25.
Sadhukhan PC, Tchetgen MB, Rackley RR, et al. Sodium pentosan polysulfate reduces urothelial responses to inflammatory stimuli via an indirect mechanism. J Urol 2002, Jul;168(1):289-92
Jain N, Li AL, Yu Y, et al. Association of macular disease with long-term use of pentosan polysulfate sodium: Findings from a US cohort. Br J Ophthalmol 2019, Nov 6.
Shah R, Simonett JM, Lyons RJ, et al. Disease course in patients with pentosan polysulfate sodium-associated maculopathy after drug cessation. JAMA Oph- thalmol 2020;138(8).
Forrest JB, Payne CK, Erickson DR. Cyclosporine A for refractory interstitial cystitis/bladder pain syndrome: Experience of 3 tertiary centers. J Urol 2012, Oct;188(4):1186-91.
Özkıdık M. Assessment of long-term intravesical hyaluronic acid, chondroitin sulfate and combination therapy for patients with bladder pain syndrome. Cent European J Urol 2019;72(3):270-5.
Moldwin RM, Hanno PM. Interstitial cystitis/bladder pain syndrome and related disorders. In: Campbell-Walsh-Wein Urology. Philadelphia: Elsevier; 2021q. p. 1224-50.
Miotla P, Cartwright R, Skorupska K, et al. Urinary retention infemale OAB after intravesical botox injection: Who is really at risk? Int Urogynecol J 2017, Jun;28(6).
Referanslar
Hanno, P, Cervigni M, Choo MS et al. Interstitial Cystitis /Bladder Pain Syndrome. In: Cardozo L, Rovner E, Wagg A, Weın A, Abrams P eds. Incontinence. 7th edn. ICUD ICS 2023. 1849-1940. ISBN: 978-0-9569607-4-0.
Castro-Diaz D, Fall M. Bladder Pain Syndrome/Interstitial Cystitis: A Large but Heterogeneous Field in Functional Urology. In Heesakkers J, Chapple C, De Ridder D, Farag F eds. Practical Functional Urology. Springer: ISBN 978-3-319-25430-2 (eBook)
Yamada Y, Nomiya A, Niimi A, et al. A survey on clinical practice of interstitial cystitis in japan. Transl Androl Urol 2015, Oct;4(5):486-90.
Parsons CL, Tatsis V. Prevalence of interstitial cystitis in young women. Urology 2004, Nov;64(5):866-70.
Nickel JC, Stephens A, Landis JR, et al. Assessment of the lower urinary tract microbiota during symptom flare in women with urologic chronic pelvic pain syndrome: A MAPP network study. J Urol 2016, Feb;195(2):356-62.
Zhang QH, Shen XC, Zhou ZS, et al. Decreased nanobacteria levels and symptoms of nano-bacteria-associated interstitial cystitis/painful bladder syndrome after tetracycline treatment. Int Urogynecol J 2010,Jan;21(1):103-9.
Aydogan TB, Gurpinar O, Koseoglu Eser O, et al. A new look at the etiology of interstitial cystitis/bladder pain syndrome: extraordinary cultivations. 2019 Nov;51(11):1961-1967.
Gamper M, Regauer S, Welter J, et al. Are mast cells still good biomarkers for bladder pain syndrome/ interstitial cystitis? J Urol 2015, Jan 14;193(6):1994-2000.
Grundy L, Caldwell A, Lumsden A, et al. Experimentally induced bladder permeability evokes bladder afferent hypersensitivity in the absence of inflammation. Front Neurosci 2020;14:590871.
Anderström C.R.; Fall M.; Johansson S.L. Scanning electron microscopic findings in interstitial cystitis. Br. J. Urol. 1989, 63, 270–275.
Van de Merwe JP. Interstitial cystitis and systemic autoimmune diseases. Nat Clin Pract Urol 2007, Sep;4(9):484-91.
Peeker R, Enerback L, Fall M, et al. Recruitment, distribution and phenotypes of mast cells in interstitial cystitis. J Urol 2000, Mar;163(3):1009-15.
Keay S, Reeder JE, Koch K, et al. Prospective evaluation of candidate urine and cell markers in patients with interstitial cystitis enrolled in a randomized clinical trial of bacillus calmette guerin (BCG). World J Urol 2007, Oct;25(5):499-504.
Ward EP, Bartolone SN, Chancellor MB, et al. Proteomic analysis of bladder biopsies from interstitial cystitis/bladder pain syndrome patients with and without hunner’s lesions reveals differences in expression of inflammatory and structural proteins. BMC Urol 2020, Nov 7;20(1):180.
Esen B, Obaid K, Suer E et al. Turkish Versions of the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) Linguistic and Psychometric Validation. ICS 2019, Gothenburg.
Tarcan T, Mangır M, Özgür MÖ et al. OAB-V8 Aşırı Aktif Mesane Sorgulama Formu Validasyon Çalışması. Üroloji Bülteni (2012), 21, 113-116.
Engeler D, Baranowski AP, Berghmans B, et al. EAU Guidelines on Chronic Pelvic Pain. 2024; https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on Chronic-Pelvic-Pain-2024.pdf
McKernan LC, Walsh CG, Reynolds WS, et al. Psychosocial co-morbidities in interstitial cystitis/bladder pain syndrome (IC/BPS): A systematic review. Neurourol Urodyn 2018;37(3):926-41.
Nordling J, Anjum FH, Bade JJ, et.al. Primary evaluation of patients suspected of having interstitial cystitis (IC). Eur Urol 2004, 45(5):662-669.
Koçak T, Acar Ö, Tarhan F, et al. Mesane Ağrısı Sendromu (İnterstisyel Sistit) Uzlaşı Metni, İstanbul 2019, ISBN: 978-605-7905-15-4
Chiang G, Patra P, Letourneau R, et al. Pentosanpolysulfate inhibits mast cell histamine secretion and intracellular calcium ion levels: An alternative explanation of its beneficial effect in interstitial cystitis. J Urol 2000, Dec;164(6):2119-25.
Sadhukhan PC, Tchetgen MB, Rackley RR, et al. Sodium pentosan polysulfate reduces urothelial responses to inflammatory stimuli via an indirect mechanism. J Urol 2002, Jul;168(1):289-92
Jain N, Li AL, Yu Y, et al. Association of macular disease with long-term use of pentosan polysulfate sodium: Findings from a US cohort. Br J Ophthalmol 2019, Nov 6.
Shah R, Simonett JM, Lyons RJ, et al. Disease course in patients with pentosan polysulfate sodium-associated maculopathy after drug cessation. JAMA Oph- thalmol 2020;138(8).
Forrest JB, Payne CK, Erickson DR. Cyclosporine A for refractory interstitial cystitis/bladder pain syndrome: Experience of 3 tertiary centers. J Urol 2012, Oct;188(4):1186-91.
Özkıdık M. Assessment of long-term intravesical hyaluronic acid, chondroitin sulfate and combination therapy for patients with bladder pain syndrome. Cent European J Urol 2019;72(3):270-5.
Moldwin RM, Hanno PM. Interstitial cystitis/bladder pain syndrome and related disorders. In: Campbell-Walsh-Wein Urology. Philadelphia: Elsevier; 2021q. p. 1224-50.
Miotla P, Cartwright R, Skorupska K, et al. Urinary retention infemale OAB after intravesical botox injection: Who is really at risk? Int Urogynecol J 2017, Jun;28(6).
