May 09,2023

TOG Article: Present status and advances in bladder pain syndrome: central sensitisation and the urinary microbiome

Key contentBladder pain syndrome (BPS) presents as a spectrum of urologicalsymptoms with poorly understood pathophysiology. Bladdermucosal injury secondary to low grade sub-clinical infection is apossible trigger, leading to nociceptive upregulation and,subsequently, central sensitisation.Brain abnormalities associated with BPS suggest thatneuropathological brain alterations exist, which may contribute tothe perceived pain.Central sensitisation plays a role in the disease pathophysiology viaan augmentation in the responsiveness of the central painsignalling neurons.The urinary microbiome is implicated as a trigger for thedevelopment and maintenance of BPS.Future directions to improve treatment strategies includestratification of patients with BPS into subtypes such as peripheralor central disease and investigation of the urinary microbiome andbladder barrier replacement.