Yukio Homma

Objectives: To investigate real‐world practices in transurethral surgeries for bladder pain syndrome (BPS) and interstitial cystitis (IC) in Japan, with a focus on procedural characteristics of hydrodistension (HD) and transurethral elimination of Hunner lesions (TUEH). Methods: An internet‐based questionnaire was sent to all members of the Society of Interstitial Cystitis of Japan in November 2024. The survey inquired about institutional characteristics, the number of procedures performed in the previous 12 months, and detailed surgical techniques. BPS was defined by the absence of Hunner lesions, and IC by their presence. Responses were analyzed to describe procedural patterns and compare practices between HD and TUEH. Results: Of 205 eligible members, 86 responded (response rate: 42%). Among them, 52 had performed HD for BPS and 67 had performed TUEH for IC within the study period. Most surgeons distended the bladder to a preset pressure of ≤ 80 cm H ₂ O for 3–10 min and repeated the procedure at least twice during HD. At TUEH, coagulation was preferred over resection to eliminate Hunner lesions. HD was frequently co‐performed, though the sequence of elimination and HD varied. Compared to HD, TUEH more often relied on abdominal palpation rather than fixed pressure, used shorter distension time, and involved longer catheter placement. Conclusions: This nationwide survey highlights contemporary surgical practices for BPS and IC in Japan. These findings may help clinicians evaluate and refine their own approaches to transurethral interventions for these complex conditions.

The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.

Non-synonymous mutations and prognosis of 97 ccRCC patients

HLA-restricted neoepitopes and expression of HLA/B2M

Correlations of gene expression with IFN-gamma and IFN-gamma-inducible immune suppressive molecules in the tumor.

Objectives: To evaluate the outcomes of partial and total cystectomy in patients with refractory Hunner‐type interstitial cystitis (HIC).Methods: Patients with end‐stage HIC who underwent supratrigonal partial cystectomy with augmentation ileocystoplasty (PC‐CP) or total cystectomy with ileal conduit (TC‐IC) were identified retrospectively. Changes in the 11‐point numerical rating scale of bladder pain and in 7‐grade quality of life (QOL) scores were evaluated. Changes in the O'Leary and Sant's Symptom Index (OSSI) and O'Leary and Sant's Problem Index (OSPI) were analyzed in patients with PC‐CP. Peri‐ and postoperative complications and patient satisfaction with overall outcomes were examined.Results: Four patients (one female) underwent PC‐CP and 13 (nine females) underwent TC‐IC. Bladder pain persisted in three PC‐CP patients, but resolved completely in all TC‐IC patients. Pain scale and QOL scores improved significantly in patients with TC‐IC (P < .01), but not in those with PC‐CP. OSSI/OSPI scores did not improve significantly in patients with PC‐CP. Three PC‐CP patients required clean intermittent catheterization due to voiding dysfunction or persistent pain. Two TC‐IC patients developed stricture of the ureteroileal anastomosis, resulting in permanent placement of a ureteral stent in one case and nephrostomy in the other. Satisfaction rate was higher in the TC‐IC than in the PC‐CP group (76.9% vs 25.0%, P < .05).Conclusions: TC‐IC provided reliable pain relief and improved QOL in patients with end‐stage HIC, but the small case number and limited methodology restrict interpretation of the results. Further studies are needed to identify appropriate candidates and optimal surgical procedures.

Electrocautery is a promising treatment option for patients with Hunner type interstitial cystitis (HIC), but frequently requires multiple sessions due to recurrence of the lesions. In the present study, we assessed the relationship between the frequency of electrocautery of Hunner lesions and changes in maximum bladder capacity (MBC) at hydrodistension in a large cohort of 118 HIC patients. Three mixed-effect linear regression analyses were conducted for MBC against (1) the number of sessions; (2) the number of sessions and the time between each session and the first session; and (3) other relevant clinical parameters in addition to the Model (2). The mean number of sessions was 2.8 times. MBC decreased approximately 50 mL for each additional electrocautery session, but this loss was offset by 10 mL for each year the subsequent session was postponed. MBC of < 400 mL at the first session was a significant risk factor for MBC loss with further sessions. No other clinical parameters were associated with MBC over time. This study demonstrates a significant relationship between the frequency of electrocautery of Hunner lesions and MBC changes in HIC patients. Low MBC at the first session is a poor prognostic marker for MBC loss over multiple sessions.

Objectives: To compare the clinical characteristics of three groups of female patients with interstitial cystitis/bladder pain syndrome (IC/BPS) classified according to the presence or absence of Hunner lesions (HL) and glomerulations.Methods: The clinical records of 100 female patients with IC/BPS who underwent their first bladder hydrodistension at our institution were retrospectively reviewed. They were divided into patients having (HL–IC; n = 57) or lacking (BPS; n = 43) HL. BPS patients were further classified as those with (29) and without (14) glomerulations. Among these three subtypes, demographics, comorbidities, symptom parameters including a visual analog scale for pain scores, O'Leary and Sant Symptom and Problem (OSSI/OSPI) Indices, frequency volume chart variables, and bladder capacity at hydrodistension were compared.Results: HL–IC patients were older and had higher OSSI/OSPI scores, greater daytime frequency and nocturia, reduced maximum and average voided volumes, and smaller bladder capacity at hydrodistension compared with BPS patients. Pain intensity and illness duration were comparable among the three groups. HL–IC patients had autoimmune disorders as comorbidities more often, but had psychiatric disorders and irritable bowel syndrome less often compared with BPS patients. No discernible differences in clinical characteristics of symptom severity and comorbid disorders were evident between BPS patients with and without glomerulations.Conclusions: The presence of HL is associated with distinctive clinical characteristics, while glomerulations are not in female patients with IC/BPS. The presence of HL, but not glomerulations, is a robust phenotypic feature of IC/BPS in women.