Currently established and emerging treatments of interstitial cystitis/bladder pain syndrome

A BSTRACT Interstitial cystitis/bladder pain syndrome (IC/BPS) is a bladder disorder with an undetermined pathogenesis. Multiple phenotypes have been identified, each with distinct clinical symptoms, bladder conditions, pain distribution patterns, and psychological profiles. To date, no treatment can provide a durable, long-term cure for this condition. Medical therapies, including analgesics, antihistamines, anti-inflammatory agents, cyclosporine, and steroids, are generally of limited effectiveness. Current bladder-directed therapies for non-Hunner’s IC/BPS, including intravesical instillation of glycosaminoglycan supplements, botulinum toxin A, low-energy shock wave, intravesical platelet-rich plasma (PRP), or steroid injections, have been widely used, but the therapeutic results are not consistent. For Hunner’s lesion, ablation is the first treatment, with the addition of intravesical PRP or triamcinolone injections shown to enhance therapeutic efficacy. In addition, pelvic floor physiotherapy and local injections can help relieve pelvic floor inflammation and pain. The integration of psychiatric consultation and cognitive behavioral therapy with bladder-directed therapy may further improve clinical outcomes. Current guidelines recommend multimodal therapy tailored to the patient’s identifiable pathophysiology and clinical presentation. Phenotyping IC/BPS based on clinical characteristics, pain distribution, cystoscopic findings, and urine biomarkers holds promise for accurately identifying specific subtypes and guiding individualized, effective bladder therapies.