The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain

This article reviews entirely new concepts concerning the etiology, presentation and diagnosis of interstitial cystitis. It pulls the information together in a concise fashion that emphasizes there is a radical change taking place in the concepts of what generates bladder symptoms. Primarily this emphasizes that the paradigm for interstitial cysititis and the generation of bladder symptoms is going to change dramatically. The data reviewed shows that the symptoms are caused by a leaky epithelium and subsequent diffusion of potassium into the tissues causing frequency, urgency, pain and incontinence. This is totally different from current concepts. The traditional diagnosis of interstitial cystitis (IC) only recognizes the severe form of the disease. The far more common early and intermittent phases of the disease are not perceived to be part of IC but rather are misdiagnosed as urinary tract infection, urethral syndrome, overactive bladder, chronic prostatitis, urethritis, or a type of gynecologic pelvic pain (such as endometriosis, vulvodynia, or some type of vaginitis). All of these patient groups actually suffer from the same bladder disease. This disease results from a leaky bladder epithelium and subsequent potassium leakage into the bladder interstitium that generates the symptoms of frequency, urgency, pain or incontinence in any combination. Robust scientific data now support this important concept. These data will be reviewed herein. The conclusions derived from these data substantially alter the paradigms for urology and gynecology in the generation of frequency, urgency and pelvic pain. All the above-mentioned syndromes unite into one primary disease process, lower urinary dysfunction epithelium, or LUDE disease, and not the 10 plus syndromes traditionally recognized.