Pathophysiology and potential multimodal therapeutic strategies for IC/BPS

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a bladder disorder with no definite aetiology and currently no effective treatment. Its clinical symptoms vary widely, and the bladder condition and extra-bladder dysfunction also show different clinical presentations. This condition is considered to have multiple factors affecting the bladder and clinical symptoms, including urothelial dysfunction, mast cell activation, autoimmune response, neurogenic inflammation, viral or bacterial infection, autonomic nervous dysfunction and central nervous sensitization. Several non-pharmacological, medical, intravesical and novel bladder therapies have been advocated, but the efficacy and durability of these treatments have not been well elucidated. Multimodal therapy has been suggested based on possible pathological mechanisms; however, the most appropriate therapeutic strategy for this disorder has not been well defined. Thus, a rational algorithm for concomitant multimodal therapy for IC/BPS has been proposed.