Urine Good Hands: Evaluation and Management of Bladder Pain in Urogynecology_OnDemand-Recording_Urine Good Hands: Evaluation and Management of Bladder Pain in Urogynecology

Video Transcription

Video Summary

In this AUGS Urogynecology webinar, Dr. Jocelyn Fitzgerald provides an in-depth exploration of female bladder pain syndrome (FBPS), formerly known as interstitial cystitis. She highlights the complexity and multifactorial nature of FBPS, focusing on its overlap with chronic pelvic pain and endometriosis. Dr. Fitzgerald emphasizes that FBPS involves symptoms such as bladder pain, pressure, and urinary persistency lasting over six weeks, typically without infection. She advocates for thorough evaluation to exclude infections, malignancies, endometriosis, and other causes.<br /><br />A key take-home is the strong association between bladder pain and endometriosis; up to 80% of patients referred for urinary symptoms without a prior endometriosis diagnosis are found to have it upon surgical evaluation. The pathophysiology often involves visceral organ cross-sensitization and neuroinflammation, with mast cells playing a central role in bladder hypersensitivity. Hormonal suppression, commonly used in these patients, may contribute to urothelial and vaginal microbiome alterations, potentially exacerbating symptoms.<br /><br />Treatment requires a multimodal approach combining education, pelvic floor physical therapy—supported by level one evidence—pharmacologic neuromodulators (e.g., amitriptyline, gabapentin), overactive bladder medications, vaginal estrogen, bladder instillations, and, in some cases, operative cystoscopy with fulguration and steroid injections. Methenamine shows promise as an anti-inflammatory agent. Psychological support is crucial due to the high impact of chronic pain on mental health.<br /><br />Dr. Fitzgerald underscores the importance of multidisciplinary care involving urogynecologists, gynecologic surgeons, gastroenterologists, rheumatologists, and mental health providers. Future directions include targeted biologics, intravesical drug delivery, PRP therapies, and novel mast cell stabilizers. Early referral to minimally invasive gynecologic surgery for endometriosis is key, as excision can improve urinary symptoms long-term.

Keywords

female bladder pain syndrome

interstitial cystitis

chronic pelvic pain

endometriosis

bladder hypersensitivity

mast cells

urothelial microbiome

pelvic floor physical therapy

neuromodulators

multidisciplinary care