Neue Erkenntnisse zur Differenzialdiagnostik des Bladder-Pain-Syndroms

Zusammenfassung

Die Diagnostik des BPS / IC (Bladder Pain Syndrom / Interstitielle Zystitis) stellt eine besondere Herausforderung dar, da nicht nur die Pathoge­nese des Syndroms sondern auch die Definition klinisch relevanter Parameter noch in lebhafter Diskussion sind. Die kürzlich von der ESSIC (European Society for the Study of IC / BPS) vorgeschlagenen Kriterien definieren, basierend auf dem Leitsymptom Blasenschmerz, eine Patientengruppe, die in sich heterogen ist und damit einer ein­heitlichen Therapie nicht zugeführt werden kann. Eine erweiterte Diagnostik auf molekula­rer Basis erscheint uns daher indiziert, um einerseits eine individualisierte Pharmakotherapie zu ermög­lichen und andererseits zur Aufklärung der Pathogenese des BPS / IC beizutragen. Dazu sehen wir eine Biopsienahme als unerlässlich. Die Diagnostik des BPS / IC sollte auf 3 „Säulen“ basieren: (1) Klinische Diagnostik, (2) Histopathologie, (3) Molekulardiagnostik / Proteinexpression. Da eine Beteiligung aller 3 zellulären Funk­tionseinheiten der Harnblase an der Pathogenese wahrscheinlich ist, sollten die Untersuchungen idealer Weise Urothel, Lamina propria und Detrusormuskulatur einschließen. Die Erstellung von Rezeptorprofilen der Detrusormuskulatur ist ein erster Ansatz für ein diagnostisches Tool, mit dem eine Individualisierung der Pharmakothe­rapie möglich erscheint. Andere Faktoren, wie etwa die Expression von beta-hCG im Urothel, ­bedürfen der weiteren Evaluation. Die Durchführung der erweiterten BPS / IC-Diagnostik könnte im Rahmen eines Klinik / Labornetzwerks realistisch in die urologische Routineversorgung integriert werden.

Abstract

The diagnosis of bladder pain syndrome / inter­stitial cystitis (BPS / IC) is challenging, since pathogenetic mechanisms and the definition of clini­cal relevant parameters are still under lively dis­cus­sion. The criteria recently proposed by the ­European Society for the Study of Interstitial Cystitis (ESSIC) define a collective of patients based on the cardinal symptom of bladder pain which is heterogeneous, and therefore cannot receive standardised consistent therapy. Thus an ex­tend­ed diagnosis based on molecular markers seems to be indicated to render individual pharmacotherapy possible, and to contribute to elucidation of BPS / IC pathogenesis. For this purpose we feel the vital need for taking a bladder biopsy. The ­diagnosis of BPS / IC should rely on 3 “columns”: (1) clinical diagnostics; (2) histopatho­logy; (3) molecular diagnostics / proteinexpres­sion. Since a significant contribution of the 3 functional units of the bladder to the pathophysiology is most evident, the examinations should ideally include urothelium, lamina propria, and detrusor mus­culature. Generation of receptor profiles of the ­detrusor muscle represents a first attempt to ­define a diagnostic tool for the individ­ualisation of BPS / IC pharmacotherapy. Other factors, e. g., beta-hCG expression in the urothelium, need ­further evaulation. Extended BPS / IC diagnostics could be realistically integrated into rou­tine pa­tient care within a clinic / laboratory network.

Schlüsselwörter

Interstitielle Zystitis - Rezeptorexpression - beta-hCG - Urothel-Pathologie - idiopathische Urge

Key words

interstitial cystitis - receptor expression - beta-hCG - urothelial pathology - idiopathic urgency

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