Etiopathogenesis of Interstitial Cystitis: A Modern Perspective

Relevance: The importance of this study is determined by the absence of a unified pathogenetic concept and the abundance of conflicting data regarding the nature of bladder pain syndrome/interstitial cystitis, which significantly complicates the selection of therapy for this patient population.

Objective: To analyze and systematize current data on the key pathogenetic mechanisms underlying the development of bladder pain syndrome/interstitial cystitis in order to establish a comprehensive understanding of the disease, which forms the basis for the future development of targeted therapeutic strategies.

Materials and methods: A search and analysis of the scientific literature was performed using PubMed, the Cochrane Library, and Elibrary. More than 40 references were selected for the review.

Conclusion: Bladder pain syndrome/interstitial cystitis is a heterogeneous disorder with a complex, multifactorial pathogenesis, in which the following interrelated mechanisms play a key role: urothelial barrier damage, chronic (including neurogenic) inflammation, autoimmune responses, oxidative stress, detrusor hypoxia, and urinary microbiota dysbiosis. Numerous studies indicate that none of these mechanisms alone can fully explain the complex clinical presentation of the disease. This underscores the need to move away from monotherapy in favor of a comprehensive treatment approach simultaneously aimed at restoring urothelial barrier function, suppressing chronic inflammation, improving blood supply to the detrusor and submucosal layers of the urothelium, alleviating neurogenic pain, and correcting associated systemic disturbances. Future therapeutic prospects are associated with the development of precision methods targeting the specific pathogenetic mechanisms identified in individual patients.

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