Reply to “Interstitial Cystitis – A Consequence of Weakened Uterosacral Ligaments Failing to Support Visceral Plexuses and Bladder Stretch Receptors and Therefore Potentially Curable?”

Article information

Int Neurourol J. 2022;26(4):352-352
Publication date (electronic) : 2022 December 30
doi :
Department of Urology, Ueda Clinic & Comfortable Urology Network, Kyoto, Japan
Corresponding author: Tomohiro Ueda Department of Urology, Ueda Clinic, 6F CUBEOIKE, 599 Bano-cho, Anekojisagaru, Karasuma-dori, Nakagyo-ku, Kyoto 604-8172, Japan Email:
Received 2021 November 29; Accepted 2022 June 9.

To the editor,

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a heterogeneous disease consisting of distinct subgroups of patients who have different underlying pathophysiology. Thus, the proposal by Prof. Petros that loose or damaged uterosacral ligaments (USLs) may be an important etiology outside the bladder to induce or worsen the symptoms of IC/BPS due to altered urothelial receptor sensitivity is interesting. However, for the proper diagnosis and treatment of IC/BPS, it is necessary to first identify bladder-centric pathophysiology including Hunner lesions by using cystoscopy and also prove that identified bladder mucosal abnormalities are the causes of bladder pain, for example, as shown by pain reduction following intravesical lidocaine instillation in the recent dimethyl sulfoxide clinical trial in IC/BPS patients [1,2]. Then, in the case that bladdercentric pathophysiology is less likely to be involved in IC/BPS symptoms, outside-bladder etiology such as the lax USL discussed here should be considered as a cause of bladder symptoms in IC/BPS patients. There will be no bright future for IC/ BPS without the following 3 steps: (1) understanding the symptoms, (2) detecting abnormal findings in or outside the bladder, and (3) verifying that the abnormality is the cause of the symptoms.


Conflict of Interest

No potential conflict of interest relevant to this article was reported.


1. Yoshimura N, Homma Y, Tomoe H, Otsuka A, Kitta T, Masumori N, et al. Efficacy and safety of intravesical instillation of KRP-116D (50% dimethyl sulfoxide solution) for interstitial cystitis/bladder pain syndrome in Japanese patients: a multicenter, randomized, double-blind, placebo-controlled, clinical study. Int J Urol 2021;28:545–53.
2. Ueda T, Hanno PM, Saito R, Meijlink JM, Yoshimura N. Current understanding and future perspectives of interstitial cystitis/bladder pain syndrome. Int Neurourol J 2021;25:99–110.

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