Preventing lesion recurrence in patients suffering from bladder pain syndrome/interstitial cystitis with Hunner lesions: a scoping review

Bladder pain syndrome or interstitial cystitis or (BPS/IC) affects approximately 83 000 men and 1.2 million women across the United States. It is now recognized that BPS/IC is a broad condition which includes patients describing 1) an unpleasant sensation such as pain, pressure, or discomfort perceived to be related to the urinary bladder, 2) associated with lower urinary symptoms, and 3) lasting for more than 6 weeks. In 2014, Nickel et al introduced the UPOINT approach (urinary, psychosocial, organ-specific, infection, neurologic and tenderness of pelvic floor) for the classification and management of BPS/IC. Patients with organ-specific symptoms may have Hunner lesions (HL) on cystoscopy. These lesions typically appear as erythematous mucosal patches with congested vessels surrounding the ulcers. When HLs are found in the context of BPS/IC, The American Urological Association (AUA) guidelines recommends specific HL-directed treatments; these include fulguration of the lesion, injections around the lesion using triamcinolone, and oral cyclosporin A for more refractory cases. Alternative off-label treatment options may include neuromodulation or major reconstructive surgery including substitution cystoplasty or urinary diversion with or without cystectomy. Nevertheless, none of those treatments are curative. Following the initial treatment, patients face recurrence of HL and associated symptom in up to 75% of cases. Little is currently known of strategies to prevent recurrence of HL. A scoping review can allow us to explore the breadth of available evidence within this specific field, summarize the literature, and identify current knowledge gaps to inform further research.