Departments of Surgery (Urology) and Anesthesiology, Washington University School of Medicine, St Louis, Missouri, USA.
Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Neurourol Urodyn. 2021 Mar;40(3):810-818. doi: 10.1002/nau.24623. Epub 2021 Feb 19.
To use the phenotyping data from the MAPP-II Symptom Patterns Study (SPS) to compare the systemic features between urologic chronic pelvic pain syndrome (UCPPS) with Hunner lesion (HL) versus those without HL.
We performed chart review on 385 women and 193 men with UCPPS who enrolled in the MAPP-II SPS. 223 had cystoscopy and documentation of HL status. Among them, 12.5% had HL and 87.5% did not.
UCPPS participants with HL were older, had increased nocturia, higher Interstitial Cystitis Symptom and Problem Indexes, and were more likely to report "painful urgency" compared with those without HL. On the other hand, UCPPS without HL reported more intense nonurologic pain, greater distribution of pain outside the pelvis, greater numbers of comorbid chronic overlapping pain conditions, higher fibromyalgia-like symptoms, and greater pain centralization, and were more likely to have migraine headache than those with HL. UCPPS without HL also had higher anxiety, perceived stress, and pain catastrophizing than those with HL. There were no differences in sex distribution, UCPPS symptom duration, intensity of urologic pain, distribution of genital pain, pelvic floor tenderness on pelvic examination, quality of life, depression, pain characteristics (nociceptive pain vs. neuropathic pain), mechanical hypersensitivity in the suprapubic area during quantitative sensory testing, and 3-year longitudinal pain outcome and urinary outcome between the two groups.
UCPPS with HL displayed more bladder-centric symptom profiles, while UCPPS without HL displayed symptoms suggesting a more systemic pain syndrome. The MAPP-II SPS phenotyping data showed that Hunner lesion is a distinct phenotype from non-Hunner lesion.
利用 MAPP-II 症状模式研究（SPS）的表型数据，比较具有 Hunner 病变（HL）与不具有 HL 的泌尿科慢性盆腔疼痛综合征（UCPPS）之间的全身特征。
我们对参加 MAPP-II SPS 的 385 名女性和 193 名男性 UCPPS 患者进行了病历回顾。其中 223 人接受了膀胱镜检查，并记录了 HL 状态。其中，12.5%有 HL，87.5%没有。
与没有 HL 的患者相比，具有 HL 的 UCPPS 患者年龄较大，夜尿增多，间质性膀胱炎症状和问题指数较高，更有可能报告“疼痛性急迫”。另一方面，没有 HL 的 UCPPS 患者报告的非泌尿科疼痛更强烈，骨盆外疼痛分布更广，合并的慢性重叠疼痛疾病更多，纤维肌痛样症状更严重，疼痛集中化程度更高，且偏头痛头痛的发生率高于 HL 患者。没有 HL 的 UCPPS 患者的焦虑、感知压力和疼痛灾难化程度也高于 HL 患者。两组之间的性别分布、UCPPS 症状持续时间、泌尿科疼痛强度、生殖器疼痛分布、骨盆检查时的骨盆底压痛、生活质量、抑郁、疼痛特征（伤害性疼痛与神经性疼痛）、定量感觉测试中耻骨上区域的机械性高敏性以及 3 年纵向疼痛结局和尿动力学结局均无差异。
具有 HL 的 UCPPS 表现出更以膀胱为中心的症状特征，而没有 HL 的 UCPPS 表现出更全身性疼痛综合征的症状。MAPP-II SPS 的表型数据表明，Hunner 病变是一种与非 Hunner 病变不同的表型。
