Hung-Yen Chin

Objective: Interstitial cystitis/bladder pain syndrome is a chronic pelvic pain condition with heterogenous mechanisms. Levator ani muscle (LAM) enthesis‐related pain has been proposed as a musculoskeletal contributor to bladder pain symptoms. This study investigated whether LAM enthesis‐related pain is independent of cystoscopic glomerulation in patients presenting with bladder pain symptoms. Methods: This single‐center retrospective study included 231 patients with painful bladder symptoms who underwent cystoscopy between January 2019 and September 2024. Patients were stratified according to the presence or absence of cystoscopic glomerulations. Demographic characteristics, lower urinary tract symptoms, and pelvic pain phenotypes were compared between groups. Logistic regression was used to assess associations between cystoscopic glomerulation and LAM pain subtypes. Results: Age, height, body weight, body mass index, and lower urinary tract symptoms did not differ significantly between groups. Glomerulations were not significantly associated with LAM pain ( P = 0.168) or enthesis‐related pain ( P = 0.372). In logistic regression analysis, glomerulations were not associated with overall LAM pain (odds ratio 0.71; 95% confidence interval 0.37–1.35; P = 0.292) or LAM enthesis‐related pain (odds ratio 0.98; 95% confidence interval 0.51–1.87; P = 0.940). Conclusions: LAM enthesis‐related pain was not significantly associated with cystoscopic glomerulation in this cohort. These findings suggest that LAM enthesis‐related pain may represent a possible musculoskeletal phenotype among patients with bladder pain syndrome; however, this hypothesis requires prospective validation.

Background: Although evidence suggests that levator ani muscle (LAM) entheseal pain is a novel etiology of chronic pelvic pain (CPP), its association with lower urinary tract symptoms (LUTS) remains underexplored. This study examined the urodynamic manifestations of LUTS in patients with LAM entheseal pain. Methods: In this retrospective cohort, women with chronic pelvic pain (CPP) and LUTS underwent standardized palpation and were divided into three groups: an isolated LAM muscular pain, an isolated LAM entheseal pain, and a combined muscle and entheseal pain group. Between-group differences in symptom prevalence and urodynamic parameters were analyzed. Results: A total of 307 female patients were enrolled. Enthesis-related pain groups exhibited significantly higher prevalences of urinary symptoms, including urinary frequency (muscle pain, n = 81 vs entheseal pain, n = 32 vs combined pain, n = 194: 82.7% vs 87.5% vs 85.1%, p = 0.011), residual urinary sensation (46.9% vs 65.6% vs 63.4%, p < 0.001), and painful bladder symptoms (45.7% vs 59.4% vs 61.9%, p < 0.001). Additionally, these groups demonstrated significantly higher rates of pain-related comorbidities, including bearing-down sensation (33.3% vs 37.5% vs 49.0%, p < 0.001), dysmenorrhea (22.2% vs 25.0% vs 35.1%, p < 0.001), irritable bowel syndrome (29.6% vs 32.4% vs 44.3%, p < 0.001), and systemic myofascial pain (28.4% vs 40.6% vs 52.6%, p < 0.001). However, direct comparison between isolated muscular and entheseal pain groups revealed no significant differences in LUTS or pain comorbidities, whereas combined pain group demonstrated the highest symptom prevalence. Notably, no significant intergroup differences were observed in urodynamic parameters. Conclusion: LAM entheseal pain represents a distinct, clinically palpable entity in CPP. Its urodynamic similarity to myofascial pain suggests that LUTS reflect a shared final pathway of central sensitization rather than peripheral structural dysfunction. Moreover, its unique association with morning stiffness supports a divergent pathophysiology.

Objective: Pelvic floor myofascial pain (PFMP), originating from the levator ani muscle (LAM) and involving both the muscle and its enthesis, might be associated with lower‐urinary‐tract symptoms (LUTS). This study investigated the relationship between PFMP and LUTS and the role of nonsteroidal anti‐inflammatory drugs (NSAIDs) in managing these conditions. Methods: Data from 722 women with LUTS, retrospectively collected from April 2020 to October 2022, were investigated. The exclusion criteria were no PFMP, incomplete data, or other comorbidities. Results: A total of 108 women received NSAID treatment (NSAID group), whereas 60 did not (non‐NSAID group). Baseline characteristics and clinical symptoms were comparable in the two groups except for significantly higher rates of residual urine sensation (71.29% vs. 51.72%, P = 0.021), enthesis pain (53.47% vs. 20.69%, P = 0.002), and morning stiffness (34.65% vs. 13.79%, P = 0.007) in the NSAID group. Although LUTS improvement did not significantly differ between the groups (63.4% vs. 53.5%, P = 0.289), pain relief was significantly greater in the NSAID group for pelvic floor muscle pain (74.26% vs. 27.59%, P < 0.001), LAM pain (40.59% vs. 13.79%, P < 0.001), and enthesis pain (44.55% vs. 6.90%, P < 0.001). LUTS improvement was strongly correlated with pain relief in both groups ( P < 0.001). Conclusion: Pelvic floor myofascial pain appears to be associated with LUTS. In women whose PFMP responds to NSAID treatment, their LUTS are also drastically alleviated. LUTS associated with PFMP or LAM enthesis pain might represent a distinct clinical category warranting further investigation.

Background: Managing chronic pelvic pain (CPP) remains a challenge due to its diverse range of causes. A newly identified anatomical entity known as the enthesis of the levator ani muscle (LAM) and its associated disorders might play a role. This paper describes a novel insight into CPP’s origin, aiming to improve accurate diagnosis and treatment. Methods: Data were collected from medical records (paper or electronic) retrospectively. The study included 112 patients meeting the criteria, divided into CPP and non-CPP groups. Clinical symptoms, including location of LAM enthesis, referred pain from pain in LAM enthesis, and related lower urinary tract symptoms (LUTSs) were discussed. To identify differences in symptoms between the groups, a Chi-squared test and descriptive analyses were conducted. Results: Bimanual examination revealed tender sites in the attachment of the LAM to the pubic bone. LAM enthesis pain presumably caused referred pain in at least 10 areas, primarily in the lower abdominal quadrate (40.2%-47.3%) followed by the inguinal area (8.9%-15.1%). Multiple LUTSs were observed, including urinary frequency (72.3%), urgency (42.9%), nocturia (53.6%), residual urine sensation (64.3%), urinary incontinence (30.3%), painful bladder (34.8%), and weak urine stream (47.9%). Patients in the CPP groups experienced significant residual urine sensation (53.6%) and bearing-down sensation (42%) compared to the non-CPP group. Conclusion: Pain in LAM enthesis is a novel cause of pelvic pain and LUTSs that warrants attention for the evaluation and management of CPP.

Overactive bladder (OAB) and interstitial cystitis/painful bladder syndrome (IC/PBS) are 2 lower urinary tract disorders with urgency and bladder pain for diagnosis and with several other shared symptoms. Because of their overlapping symptoms, precise differential diagnosis of OAB and IC/PBS remains difficult. Thus, we characterize a subgroup of OAB with bladder pain (OAB-BP) that can be differentiated from OAB alone by urodynamic study (UDS) findings. We also further examined the clinical presentations and urodynamic parameters of OAB alone, OAB-BP, and IC/PBS. Data were collected between September 2018 and April 2019. Patients were categorized into 3 groups, OAB-alone (no bladder pain during UDS, n = 39), OAB-BP (with bladder pain during UDS, n = 35), and IC/PBS (the comparator, n = 39). Chi-square tests were used to compare OAB alone, OAB-BP, and IC/PBS with respect to their clinical presentations and urodynamic parameters. Factors with P < .05 were further analyzed through post hoc comparisons with Bonferroni adjustment. An unique subgroup of OAB patients was identified (i.e., OAB-BP), bladder pain can only be induced at maximal cytometric capacity during UDS. We also identified that the case histories and UDS parameters (e.g., low first desire, normal desire, and maximum cytometric capacity) of the OAB-BP group were more similar to those of the IC/PBS group than to those of the OAB-alone group. The OAB-BP group and the IC/PBS group reported more intrusive, longer-lasting symptoms before their final diagnoses, more extensive family history of urinary tract disorder, and more associated comorbidities (e.g., irritable bowel syndrome, and myofascial pain) than the OAB-alone group. The UDS assessment induced bladder pain in the OAB-BP group to reveal their hidden symptoms. Careful attention to patient history and sophisticated UDS evaluation may help to identify this unique OAB group.

Almost one-fifth of the people in the world experience a decrease in quality of life due to overactive bladder (OAB) syndrome. The main bothersome symptoms are urgency accompanied by urinary frequency and nocturia. This chronic, disabling condition is first managed by reducing fluid intake and pelvic floor muscle training, supplemented with antimuscarinic drugs, if necessary. However, refractory cases often still occur. In more severe cases, invasive surgical interventions can be considered; yet, the success rate is still inconsistent, and there is a high complication rate. This condition is frustrating for patients and challenging for the medical staff involved. Although its pathophysiology has not been fully elucidated, peripheral autonomic somatic and sensory afferent receptors are considered to be involved in this condition. Hence, currently, physical agent-based treatments such as neuromodulation have taken a significant place in the third-line therapy of OAB. The efficacy and safety profiles of electrical and magnetic stimulation continue to evolve. Physical-based agents provide an appealing option owing to their effectiveness and minimal side effects. In addition, more physical therapies using light and shock energy are currently being investigated. Thus, a comprehensive understanding of these modalities is an extremely important aspect to provide the most suitable modalities for patients.

Background: Pregnancy and childbirth are frequently associated with overactive bladder syndrome (OAB). However, the role of parous effects in OAB among nulliparous (NP) women remains controversial. Methods: This study investigated abnormal voiding patterns and detrusor overactivity (DO) among NP women with OAB in comparison with parous women. From August 2011 to December 2018, 906 patients met the inclusion criteria for participation and were divided into three groups: 221 patients in the NP group, 571 patients in the normal spontaneous delivery (NSD) group, and 114 patients in the cesarean section (CS) group. Urodynamic study examinations were performed, and the presence of DO, abnormal voiding patterns, and maximum urethral closure pressure (MUCP) was recorded. Data were analyzed using analysis of variance, χ² tests, and independent t tests. Results: Compared with parous women in the NSD and CS groups, patients in the NP group had a significantly higher prevalence of abnormal voiding patterns, DO, and MUCP. Furthermore, abnormal voiding patterns were significantly associated with DO and MUCP, respectively, especially in the NP group. Conclusion: We hypothesized that hypertonicity or poor relaxation of the pelvic muscle in NP women may cause functional BOO, which is related to their OAB.

Interstitial cystitis/bladder pain syndrome (IC/BPS) negatively affects the quality of life. In this study, we investigated the lifestyle behavioral changes patients with IC/BPS make to cope with their symptoms. This prospective study was conducted between August 2018 and June 2019. All patients had a primary symptom of suprapubic pain with a full bladder and other lower urinary tract symptoms for more than 6 weeks as well as cystoscopic findings. All participants completed our self-developed questionnaire, which included informations about their living and work environment, occupational garments, dietary habits, and personal habits. Continuous variables were compared using an independent sample t test, and categorical variables were compared using a chi-square test. We recruited 86 patients with IC/BPS and age-matched 86 controls without IC/BPS. In our study, patients with IC/BPS had more cranberry intake (45.34% vs. 5.81%, P < 0.05) than non-IC/BPS controls; the IC/BPS group had decreased consumption of coffee and spicy food; and wore less makeup or special work garments. In conclusion, patients with IC/BPS tend to make several lifestyle behavioral changes to cope with their symptoms.

Pregnancy and childbirth are frequently associated with overactive bladder syndrome (OAB). However, the role of parous effects in OAB among nulliparous (NP) women remains controversial. This study investigated abnormal voiding patterns and DO among NP woman with OAB in comparison with parous women. From August 2011 to December 2018, 906 patients met the inclusion criteria for participation and were divided into three groups: 221 patients in the NP group, 571 patients in the normal spontaneous delivery (NSD) group, and 114 patients in the cesarean section (CS) group. Urodynamic study (UDS) examinations were performed, and the presence of DO, abnormal voiding patterns, and maximum urethral closure pressure (MUCP) were recorded. Data were analyzed using analysis of variance, χ2 tests, and independent t tests. Compared with parous women in the NSD and CS groups, patients in the NP group had a significantly higher prevalence of abnormal voiding patterns, DO and MUCP. Furthermore, abnormal voiding patterns were significantly associated with DO and MUCP respectively, especially in the NP group. We hypothesized that hypertonicity or poor relaxation of the pelvic muscle in NP women may cause functional BOO, which is related to their OAB.

Objective: Traumatic brain injuries (TBIs) are a prime public health challenge with a high incidence of mortality, and also reflect severe economic impacts. One of their severe symptoms is bladder dysfunction. Conventional therapeutic methods are not effective in managing bladder dysfunction. Henceforth, a research endeavor was attempted to explore a new therapeutic approach for bladder dysfunction through deep brain stimulation (DBS) procedures in a TBI animal model. Methods: TBI in this animal model was induced by the weight-drop method. All rats with an induced TBI were housed for 4 weeks to allow severe bladder dysfunction to develop. Subsequently, an initial urodynamic measurement, the simultaneous recording of cystometric (CMG) and external urethral sphincter electromyography (EUS-EMG) activity was conducted to evaluate bladder function. Further, standard DBS procedures with varying electrical stimulation parameters were executed in the target area of the pedunculopontine tegmental nucleus (PPTg). Simultaneously, urodynamic measurements were re-established to compare the effects of DBS interventions on bladder functions. Results: From the variable combinations of electrical stimulation, DBS at 50 Hz and 2.0 V, significantly reverted the voiding efficiency from 39% to 69% in TBI rats. Furthermore, MRI studies revealed the precise localization of the DBS electrode in the target area. Conclusions: The results we obtained showed an insightful understanding of PPTg-DBS and its therapeutic applications in alleviating bladder dysfunction in rats with a TBI. Hence, the present study suggests that PPTg-DBS is an effective therapeutic strategy for treating bladder dysfunction.