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Case Reports
. 2024 Jul 31;16(7):e65829.
doi: 10.7759/cureus.65829. eCollection 2024 Jul.

Mathematical Approach to Synergistic Management of Bladder Pain Syndrome/Interstitial Cystitis and Vulvodynia: A Case Series Utilizing Principal Component Analysis, Cluster Analysis, and Combination Laser Therapy

Affiliations
Case Reports

Mathematical Approach to Synergistic Management of Bladder Pain Syndrome/Interstitial Cystitis and Vulvodynia: A Case Series Utilizing Principal Component Analysis, Cluster Analysis, and Combination Laser Therapy

Nobuo Okui et al. Cureus. .

Abstract

This case series presents three patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and vulvodynia, demonstrating the efficacy of an individualized treatment approach using cluster analysis and combination laser therapy. Principal component analysis (PCA) was used to visualize the dynamic nature of symptom clusters and guide treatment decisions. Case 1 was a 41-year-old woman initially classified as Cluster 1 (PCA coordinates: 1.65, 0.03) transitioned to Cluster 2 (-16.93, -21.75) after bladder hydrodistension. Subsequent Fotona laser (Ljubljana, Slovenia) treatment resulted in the complete resolution of symptoms. Case 2 was a 55-year-old woman, contraindicated for hormone therapy due to breast cancer history, presented as Cluster 2 (PCA coordinates: -24.16, 8.74). Fotona laser treatment shifted her to Cluster 1 (11.22, -20.22), followed by bladder hydrodistension for complete cure. Case 3 was a 49-year-old woman, initially in Cluster 0 (PCA coordinates: 1.892, 30.11), who underwent fulguration for Hunner's lesions. Posttreatment, she moved to Cluster 2 (-24.31, 1.767) and achieved full recovery after Fotona laser therapy. The dynamic nature of symptom clusters, visualized through PCA, guided treatment decisions. The PCA transformation, represented as y =WTz, where z is the standardized symptom vector and W is the principal component matrix, allows for the objective tracking of symptom changes. Combination Fotona laser therapy, including vaginal erbium YAG and neodymium YAG, has proven effective in managing vulvar pain, particularly when hormone therapy is contraindicated. This approach, addressing both urological and gynecological aspects, resulted in sustained symptom improvement for over 12 months in all cases. This case series highlights the synergistic relationship between BPS/IC and vulvodynia, demonstrating the efficacy of comprehensive, adaptive treatment strategies guided by mathematical analysis for complex pelvic pain syndromes.

Keywords: bladder pain syndrome; cluster analysis; interstitial cystitis; laser therapy; synergistic management; vulvodynia.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Yokosuka Urogynaecology and Urology Clinic issued approval Approval no. 24-C005. This case report was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all patients, and written consent was signed by the patients. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) according to the guidelines
IC/BPS: Interstitial Cystitis/Bladder Pain Syndrome Original figure created by the authors, adapted from the concept presented in [16].
Figure 2
Figure 2. Vaginal non-ablative erbium YAG laser (VEL) tools and anatomical models
a. Tools used for VEL: A, glass speculum; B, PS03-GA handpiece for irradiating the anterior vaginal wall; C, R11-GC handpiece for irradiating the entire vaginal circumference. b. Insertion of PS03-GA (B) into the glass speculum (A). c. Insertion of PS03-GA (B) handpiece into a silicone model after inserting the glass speculum (A). The photos in this figure are all original images. Additionally, the photographs of the equipment used were taken with permission from Fotona d.o.o (Ljubljana, Slovenia). d. Insertion of R11-GC (C) handpiece into the silicone model after inserting the glass speculum (A). e. Glass speculum (A) and handpiece PS03-GA (B) inserted in a plastic anatomical model, showing the anatomical position.  f. Glass speculum (A) and handpiece R11-GC (C) inserted in a plastic anatomical model, showing the anatomical position. Ps: pubic symphysis; Ur: urethra; V: vagina; R: rectum; Bl: bladder; U: uterus.
Figure 3
Figure 3. Tools and models for understanding Neodymium YAG laser (Nd:YAG)
Figure 3a: Laser tools. R33 non-contact handpiece Figure 3b: Irradiation process using R33. Figure 3c: the irradiation sites The photos in this figure are all original images. Additionally, the photographs of the equipment used were taken with permission from Fotona d.o.o. (Ljubljana, Slovenia).
Figure 4
Figure 4. Three Clusters and Changes in Coordinates for Case 1
The two black dots represent Case 1 at the initial visit (T0) and three months after bladder hydrodistension treatment (T6). PCA1 and PCA2 are the principal components that capture the maximum variance in the data, visually distinguishing the symptom profiles of each cluster. Cluster 0 is represented in red, Cluster 1 in green, and Cluster 2 in blue [11]. The y-axis represents PCA2, and the x-axis represents PCA1. The yellow “X” marks indicate the centroids of the clusters, capturing the central points of each cluster in the reduced dimensional space [11]. PCA, principal component analysis
Figure 5
Figure 5. Three Clusters and Changes in Coordinates for Case 2
The two black dots represent Case 1 at the initial visit (T0) and three months after Fotona laser (Fotona d.o.o., Ljubljana, Slovenia) treatment (T6). PCA1 and PCA2 are the principal components that capture the maximum variance in the data, visually distinguishing the symptom profiles of each cluster. Cluster 0 is represented in red, Cluster 1 in green, and Cluster 2 in blue [11]. The y-axis represents PCA2, and the x-axis represents PCA1. The yellow “X” marks indicate the centroids of the clusters, capturing the central points of each cluster in the reduced dimensional space [11]. PCA, principal component analysis
Figure 6
Figure 6. Three Clusters and Changes in Coordinates for Case 3
The two black dots represent Case 1 at the initial visit (T0) and three months after Fotona laser (Fotona d.o.o., Ljubljana, Slovenia) treatment (T6). PCA1 and PCA2 are the principal components that capture the maximum variance in the data, visually distinguishing the symptom profiles of each cluster. Cluster 0 is represented in red, Cluster 1 in green, and Cluster 2 in blue [11]. The y-axis represents PCA2, and the x-axis represents PCA1. The yellow “X” marks indicate the centroids of the clusters, capturing the central points of each cluster in the reduced dimensional space [11]. PCA, principal component analysis

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