Challenges and current evidence on the management of bladder pain syndrome

Bladder pain syndrome (BPS) is an enigmatic condition, which can be debilitating for the patients, affecting their quality of life. Its prevalence is believed to have become markedly higher (100-300/100,000 women) than in previous years. Its etiology and pathogenesis remain unknown, and a number of theories based on clinical and experimental observations have been developed. It is difficult to be diagnosed and treated. There is a worldwide effort to standardize its nomenclature, definition, diagnosis, and treatment algorithm. The aim of this review is to critically appraise the current evidence on the diagnosis and management of BPS.

We performed a review of the literature (Pubmed, Embase, Cochrane, Google Scholar, conference proceedings) as well as consensus statements and guidelines from relevant professional societies. We have critically compared these statements and guidelines with emphasis on the controversies.

Patients may experience pain and lower urinary tract symptoms for a long time before diagnosis, affecting their mental health and work, causing stress, sleep disturbance, depression, and sexual dysfunction. BPS has been considered as one of a group of chronic pain syndromes rather than as primarily an inflammatory bladder disorder. Despite the wide range of treatments, most are empirical and inadequate, usually offering just symptom relief. There is often delay in commencing treatment, and this may result in worse prognosis.

Efforts are focused on different pathways for the early identification of this syndrome, trying to elucidate the pathogenetic mechanism, as well as introducing effective treatments.