The posterior fornix syndrome is an important differential diagnosis for interstitial cystitis/bladder pain syndrome
Background: The catalyst for this analysis was a statement by Dr. Magnus Fall at a meeting of invited experts in 2020 of IC/BPS (interstitial cystitis/bladder pain syndrome): “A paradigm shift in the understanding of IC/BPS is urgent.” This review analyses such a paradigm shift. Summary: The paradig...
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| Hauptverfasser: | , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
August 4, 2025
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| In: |
Urologia internationalis
Year: 2026, Jahrgang: 110, Heft: 3, Pages: 306-316 |
| ISSN: | 1423-0399 |
| DOI: | 10.1159/000547785 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1159/000547785
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| Verfasserangaben: | Peter Emanuel Petros, Maren Juliane Wenk, Bernhard Liedl, Klaus Goeschen, Jacob Bornstein |
| Zusammenfassung: | Background: The catalyst for this analysis was a statement by Dr. Magnus Fall at a meeting of invited experts in 2020 of IC/BPS (interstitial cystitis/bladder pain syndrome): “A paradigm shift in the understanding of IC/BPS is urgent.” This review analyses such a paradigm shift. Summary: The paradigm shift began with the serendipitous cure of Hunner’s lesion in a woman with a diagnosis of posterior fornix syndrome (PFS) and uterine prolapse. Retrospective analysis of surgical data from eight PFS studies reporting pain and urge cure found PFS was consistent with IC/BPS definitions. No Hunner’s lesions/ulcers were reported in the eight studies. Anatomical pathways for urge/frequency were consistent with Tanagho’s descriptions of normal micturition (albeit prematurely activated); pathways for abnormal emptying/retention were consistent with inability of pelvic muscles to open the posterior urethral wall prior to micturition; pathways for pelvic pain were consistent with de novo impulses from pelvic visceral plexuses caused by unsupported USLs (uterosacral ligaments). Key Messages: As PFS and IC/BPS have similar symptoms, USL repair of prolapse can potentially deliver improvement/cure for urge and pain symptoms, provided diagnostic PFS criteria (e.g., speculum test) for PFS are met. Two hypotheses explain inflammatory end-organ responses observed in Hunner’s IC/BPS and offer new research directions. Interstitial cystitis/bladder pain syndrome (IC/BPS) is a bladder condition, which consists of pelvic pain and “urge to go,” with sometimes an ulcer in the bladder called Hunner’s ulcer. At present, interstitial cystitis is considered incurable with no known cause. This paper concerns a serendipitous discovery of cure of Hunner’s lesion by repairing the suspensory ligaments of the uterus (uterosacral) in a 73-year-old woman for a different condition, prolapse, urge, pain, and bladder emptying problems, known as the “posterior fornix syndrome” (PFS). High cure rates for these symptoms were confirmed in eight different studies comprising hundreds of women with PFS. The question this paper analyses is, “are PFS and IC/BPS one and the same condition in some women who have IC/BPS?” If so, then IC/BPS is potentially curable by repair of the uterosacral ligaments. |
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| Beschreibung: | Gesehen am 28.10.2025 |
| Beschreibung: | Online Resource |
| ISSN: | 1423-0399 |
| DOI: | 10.1159/000547785 |