Urologic Chronic Pelvic Pain Syndrome Flares: A Comprehensive, Systematic Review and Meta-Analysis of the Peer-Reviewed Flare Literature

No AccessJournal of UrologyReview Science1 Mar 2024Urologic Chronic Pelvic Pain Syndrome Flares: A Comprehensive, Systematic Review and Meta-Analysis of the Peer-Reviewed Flare Literature Emily S. Barker, Kimberley Chiu, Victoria L. Brown, Haidy Morsy, Lauren H. Yaeger, Arya Catna, Ratna Pakpahan, Robert Moldwin, Barbara Shorter, Jerry L. Lowder, H. Henry Lai, and Siobhan Sutcliffe Emily S. BarkerEmily S. Barker , Kimberley ChiuKimberley Chiu , Victoria L. BrownVictoria L. Brown , Haidy MorsyHaidy Morsy , Lauren H. YaegerLauren H. Yaeger , Arya CatnaArya Catna , Ratna PakpahanRatna Pakpahan , Robert MoldwinRobert Moldwin , Barbara ShorterBarbara Shorter , Jerry L. LowderJerry L. Lowder , H. Henry LaiH. Henry Lai , and Siobhan SutcliffeSiobhan Sutcliffe Corresponding Author: Siobhan Sutcliffe, PhD, Department of Surgery, Washington University School of Medicine, 600 S Taylor Ave, St Louis, MO 63110 ( ([email protected]) https://orcid.org/0000-0002-4613-8107 View All Author Informationhttps://doi.org/10.1097/JU.0000000000003820AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to systematically review and summarize the peer-reviewed literature on urologic chronic pelvic pain syndrome flares, including their terminology, manifestation, perceived triggers, management and prevention strategies, impact on quality of life, and insights into pathophysiologic mechanisms, as a foundation for future empirical research. Materials and Methods: We searched 6 medical databases for articles related to any aspect of symptom exacerbations for interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. A total of 1486 abstracts and 398 full-text articles were reviewed, and data were extracted by at least 2 individuals. Results: Overall, we identified 59 articles, including 36 qualitative, cross-sectional, or case-control; 15 cohort-based; and 8 experimental articles. The majority of studies described North American patients with confirmed diagnoses. "Flare" was a commonly used term, but additional terminology (eg, exacerbation) was also used. Most flares involved significant increases in pain intensity, but less data were available on flare frequency and duration. Painful, frequent, long-lasting, and unpredictable flares were highly impactful, even over and above participants' nonflare symptoms. A large number of perceived triggers (eg, diet, stress) and management/prevention strategies (eg, analgesics, thermal therapy, rest) were proposed by participants, but few had empirical support. In addition, few studies explored underlying biologic mechanisms. Conclusions: Overall, we found that flares are painful and impactful, but otherwise poorly understood in terms of manifestation (frequency and duration), triggers, treatment, prevention, and pathophysiology. These summary findings provide a foundation for future flare-related research and highlight gaps that warrant additional empirical studies. REFERENCES 1. . The MAPP Research Network: a novel study of urologic chronic pelvic pain syndromes. BMC Urol. 2014; 14:57. Crossref, Medline, Google Scholar 2. . Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011; 186(2):540-544. Link, Google Scholar 3. . 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J Urol. 2023; 209(1):216-224. Link, Google Scholar Support: This review was funded by NIH research grants R01DK129226, U01DK082315, and T32DK120497. Conflict of Interest Disclosures: R.M.: Abbvie Pharmaceuticals: PI and consultant, Ironwood Pharmaceuticals: PI and consultant, Kuste Pharmaceuticals: PI and consultant, Trigone Pharmaceuticals: Consultant, Vaneltix Pharmaceuticals: PI; J.L.L.: Expert witness; H.L.: Medtronic: Consultant, Astella: Consultant, IronWood: Consultant, BioHaven: Consultant, Aquinox: Consultant, Teva: Consultant, MicroGenDx: Consultant, Neuspera: Data and safety monitoring board. All other authors have nothing to disclose. Ethics Statement: As this systematic review and meta-analysis did not include human subjects research—only a review and synthesis of published, aggregated data from the literature and select de-identified primary data—we did not seek Institutional Review Board approval. Author Contributions: Conception and design: L.H.Y., J.L.L., E.S.B., K.C., H.H.L., S.S.; Data analysis and interpretation: V.L.B., R.P., R.M., B.S., J.L.L., E.S.B., K.C., H.H.L., S.S.; Data acquisition: H.M., L.H.Y., E.S.B., K.C., A.C., S.S.; Critical revision of the manuscript for scientific and factual content: V.L.B., H.M., L.H.Y., R.P., J.L.L., E.S.B., K.C., A.C., H.H.L.; Drafting the manuscript: L.H.Y., R.M., B.S., J.L.L., E.S.B., K.C., S.S.; Statistical analysis: R.P., E.S.B., K.C., S.S.; Supervision: R.M., A.C., H.H.L., S.S. Data Availability: All extracted aggregate data were presented in the main and supplementary tables of the manuscript. Primary data from individual studies can be requested from the authors of the original studies. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 3March 2024Page: 341-353Supplementary Materials Peer Review Report Open Peer Review Report Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordsinterstitial cystitisbladder pain syndromechronic prostatitischronic pelvic pain syndromesymptom exacerbationAcknowledgmentsWe thank members of the MAPP Research Network for thoughtful flare-related discussions.Metrics Author Information Emily S. Barker Co-first authors. More articles by this author Kimberley Chiu Co-first authors. More articles by this author Victoria L. Brown More articles by this author Haidy Morsy More articles by this author Lauren H. Yaeger More articles by this author Arya Catna More articles by this author Ratna Pakpahan More articles by this author Robert Moldwin More articles by this author Barbara Shorter More articles by this author Jerry L. Lowder More articles by this author H. Henry Lai More articles by this author Siobhan Sutcliffe Corresponding Author: Siobhan Sutcliffe, PhD, Department of Surgery, Washington University School of Medicine, 600 S Taylor Ave, St Louis, MO 63110 ( ([email protected]) More articles by this author Expand All Support: This review was funded by NIH research grants R01DK129226, U01DK082315, and T32DK120497. Conflict of Interest Disclosures: R.M.: Abbvie Pharmaceuticals: PI and consultant, Ironwood Pharmaceuticals: PI and consultant, Kuste Pharmaceuticals: PI and consultant, Trigone Pharmaceuticals: Consultant, Vaneltix Pharmaceuticals: PI; J.L.L.: Expert witness; H.L.: Medtronic: Consultant, Astella: Consultant, IronWood: Consultant, BioHaven: Consultant, Aquinox: Consultant, Teva: Consultant, MicroGenDx: Consultant, Neuspera: Data and safety monitoring board. All other authors have nothing to disclose. Ethics Statement: As this systematic review and meta-analysis did not include human subjects research—only a review and synthesis of published, aggregated data from the literature and select de-identified primary data—we did not seek Institutional Review Board approval. Author Contributions: Conception and design: L.H.Y., J.L.L., E.S.B., K.C., H.H.L., S.S.; Data analysis and interpretation: V.L.B., R.P., R.M., B.S., J.L.L., E.S.B., K.C., H.H.L., S.S.; Data acquisition: H.M., L.H.Y., E.S.B., K.C., A.C., S.S.; Critical revision of the manuscript for scientific and factual content: V.L.B., H.M., L.H.Y., R.P., J.L.L., E.S.B., K.C., A.C., H.H.L.; Drafting the manuscript: L.H.Y., R.M., B.S., J.L.L., E.S.B., K.C., S.S.; Statistical analysis: R.P., E.S.B., K.C., S.S.; Supervision: R.M., A.C., H.H.L., S.S. Data Availability: All extracted aggregate data were presented in the main and supplementary tables of the manuscript. Primary data from individual studies can be requested from the authors of the original studies. Advertisement PDF downloadLoading ...