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Hunner’s Lesions Should Be Considered A Separate Disease

As we’ve discussed in earlier issues of the IC Optimist, many clinicians and researchers around the world now believe that there are distinct variations and/or subtypes in the IC patient population. While there is considerable debate of proposed subtyping systems, most agree that the roughly 10% of patients who struggle with Hunner’s lesions have a distinct bladder disease that differentiates them from the vast majority of currently diagnosed IC/BPS patients. Patients with Hunner’s lesions have significantly lower bladder capacity and their biopsy results show profound inflammation NOT found in patients without Hunner’s lesions.

At September’s International Continence Society meeting (Tokyo, Japan), Dr. Christopher Payne (Vista Urology, San Jose CA) argued “If we were starting over today”, he said, “we would never combine ulcerative interstitial cystitis with Bladder Pain Syndrome. Ulcerative interstitial cystitis is its own specific disease.” (1) He, and other key researchers, argue that that it has been unfair to the Hunner’s lesion patient community to combine these two distinct patient populations, compromising not only research studies but also patient care. He continued “If we separate it out and research it independently we can treat it successfully and maybe find a cure.”

In Europe, only patients with Hunner’s lesions are diagnosed with “interstitial cystitis”. The great majority of patients are diagnosed with “Bladder Pain Syndrome.” This begs the question ‘What exactly is bladder pain syndrome?”

Dr. Payne offered:

Most patients diagnosed with IC/BPS actually have Bladder Pain Syndrome. The key word is SYNDROME. There is an underlying assumption that this is a disorder of the bladder and is due to chronic inflammation. Both assumptions are generally false and bladder-centric treatments have poor response…. It is abundantly clear that BPS (without Hunner’s lesion) is most commonly a complex phenotype of neuromuscular-psychosocial disorder. Other BPS phenotypes that may be explored include neuropathies (pudendal and other), allergy driven BPS and systemic pain.(4)

He vehemently argues that applying a general treatment algorithm to this diverse patient population is both ineffective and, perhaps, meaningless. He said “Treatment must be individualized to the particular patient’s disease.” Dr. Yuko Homma of Japan agreed. He said “We should not treat the patients as a single entity because of similar symptoms.”

In 2015, Dr. Payne proposed a five point subtyping system to create customized treatment plans for patients that has worked remarkably well in our ICN wellness coaching sessions.(3) You can expect much more discussion about potential subtypes of IC/BPS in the coming year.

Hunner’s lesions should be considered a separate disease from IC/BPS. It is, perhaps, the only true “bladder disease” under the collective title “IC/BPS.” A 2015 research study linked lesions to a rare viral infection (polyoma BK) of the bladder wall.(4) These patients need specialized care and their own unique research studies. Thankfully, they have one very promising treatment currently in development. Early results for the LiRIS device shared this Fall showed a reduction in the number and size of lesions.(5)

References:

  1. Meijlink, J. Review of the 46th Annual Meeting of the ICS. International Painful Bladder Foundation. Accessed: 11/4/16 – http://www.painfulbladder.org/pdf/2016_ICS_Tokyo.pdf
  2. Osborne J. The New Paradigm for IC & Pelvic Pain: Do you know your phenotype? IC Optimist. Summer 2015. p5-9
  3. Payne C. ICS 2016 Meeting In Tokyo, Japan. Vista Urology News. September 13, 2016.
  4. Van der Aa F, et al. Polyomavirus BK–a potential new therapeutic target for painful bladder syndrome/interstitial cystitis? Med Hypotheses. 2014 Sep;83(3):317-20.
  5. Krader, C. Device efficacious for treating IC with Hunner’s lesions. Urology Times. October 2, 2016
By | 2017-01-18T12:01:11+00:00 November 9th, 2016|Front Page Feed, Interstitial Cystitis Network Blog|Comments Off on Hunner’s Lesions Should Be Considered A Separate Disease

About the Author:

My Google Profile+ Jill Heidi Osborne is the president and founder of the Interstitial Cystitis Network, a health education company dedicated to interstitial cystitis, bladder pain syndrome and other pelvic pain disorders. As the editor and lead author of the ICN and the IC Optimist magazine, Jill is proud of the academic recognition that her website has achieved. The University of London rated the ICN as the top IC website for accuracy, credibility, readability and quality. (Int Urogynecol J - April 2013). Harvard Medical School rated both Medscape and the ICN as the top two websites dedicated to IC. (Urology - Sept 11). Jill currently serves on the Congressionally Directed Medical Research Panel (US Army) where she collaborates with researchers to evaluate new IC research studies for possible funding. Jill has conducted and/or collaborates on a variety of IC research studies on new therapeutics, pain care, sexuality, the use of medical marijuana, menopause and the cost of treatments, shining a light on issues that influence patient quality of life. An IC support group leader and national spokesperson for the past 20 years, she has represented the IC community on radio, TV shows, at medical conferences. She has written hundreds of articles on IC and its related conditions. With a Bachelors Degree in Pharmacology and a Masters in Psychology, Jill was named Presidential Management Intern (aka Fellowship) while in graduate school. (She was unable to earn her PhD due to the onset of her IC.) She spends the majority of her time providing WELLNESS COACHING for patients in need and developing new, internet based educational and support tools for IC patients, including the “Living with IC” video series currently on YouTube and the ICN Food List smartphone app! Jill was diagnosed with IC at the age of 32 but first showed symptoms at the age of 12.