Clinical guidelines for interstitial cystitis/bladder pain syndrome
Yukio HommaYoshiyuki AkiyamaHikaru TomoeAkira FurutaTomohiro UedaDaichi MaedaAlex TL LinHann‐Chorng KuoMing‐Huei LeeSeung‐June OhJoon Chul KimKyu‐Sung Lee
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Abstract:
Abstract The clinical guidelines for interstitial cystitis and related symptomatic conditions were revised by updating our previous guidelines. The current guidelines define interstitial cystitis/bladder pain syndrome as a condition with chronic pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by other urinary symptoms, such as persistent urge to void or urinary frequency in the absence of confusable diseases. The characteristic symptom complex is collectively referred as hypersensitive bladder symptoms. Interstitial cystitis/bladder pain syndrome is divided into Hunner‐type interstitial cystitis and bladder pain syndrome; Hunner‐type interstitial cystitis and bladder pain syndrome represent interstitial cystitis/bladder pain syndrome with Hunner lesions and interstitial cystitis/bladder pain syndrome without Hunner lesions, respectively. So‐called non‐Hunner‐type interstitial cystitis featured by glomerulations or bladder bleeding after distension is included in bladder pain syndrome. The symptoms are virtually indistinguishable between Hunner‐type interstitial cystitis and bladder pain syndrome; however, Hunner‐type interstitial cystitis and bladder pain syndrome should be considered as a separate entity of disorder. Histopathology totally differs between Hunner‐type interstitial cystitis and bladder pain syndrome; Hunner‐type interstitial cystitis is associated with severe inflammation of the urinary bladder accompanied by lymphoplasmacytic infiltration and urothelial denudation, whereas bladder pain syndrome shows little pathological changes in the bladder. Pathophysiology would also differ between Hunner‐type interstitial cystitis and bladder pain syndrome, involving interaction of multiple factors, such as inflammation, autoimmunity, infection, exogenous substances, urothelial dysfunction, neural hyperactivity and extrabladder disorders. The patients should be treated differently based on the diagnosis of Hunner‐type interstitial cystitis or bladder pain syndrome, which requires cystoscopy to determine the presence or absence Hunner lesions. Clinical studies are to be designed to analyze outcomes separately for Hunner‐type interstitial cystitis and bladder pain syndrome.Keywords:
Bladder Pain Syndrome
Objective
To provide an updated clinical framework for the definition, diagnosis and treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) according to the current available best evidence and advises a multimodal approach in its management.
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Interstitial cystitis and chronic prostatitis remain clinical enigmas, partly because the conditions are so ill-defined, partly because they overlap so much with each other and other local and systemic pain syndromes, and partly because our management strategies are rather poor. Recently, the condition traditionally identified as interstitial cystitis has become known as interstitial cystitis/painful bladder syndrome (IC/PBS), painful bladder syndrome, and/or bladder pain syndrome, whereas chronic nonbacterial prostatitis syndromes have become known as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) or simply chronic pelvic pain syndrome. The overall purpose of the National Institutes of Health (NIH) Urologic Chronic Pelvic Pain Workshop was to begin to redefine these 2 major urologic pelvic pain syndromes in the context of the other major syndromes with which they are commonly associated (eg, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome). The specific aims of the workshop were to discuss disease definitions and diagnostic protocols of these major chronic pelvic pain disorders, discuss the interrelationships among these disorders, and identify common symptomatology and diagnostic assessment to ensure complete evaluation of all relevant comorbidities. Finally, it was hoped that the workshop would lead to development of a diagnostic algorithm that could be tested in a “pilot” study.
The participants included a planning committee, a designated advisory panel, and interested researchers, clinicians, patients, and other stakeholders. The following is a brief synopsis of the discussion.
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The European Society for the Study of Interstitial Cystitis/Painful Bladder Syndrome (ESSIC) has recently suggested a change of the name to bladder pain syndrome (BPS) to differentiate it from other urologic pain syndromes such as urethral pain syndrome, prostate pain syndrome, and others.1,2 The Washington DC Consensus Group on IC/PBS favoured retaining the name interstitial cystitis/painful bladder syndrome.3
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Endometriosis and interstitial cystitis/painful bladder syndrome share similar symptoms. Interstitial cystitis was once considered rare, but it is now recognized as more common than previously thought. This review examines evidence that patients presenting with symptoms typically attributed to endometriosis or with unresolved pelvic pain after treatment for endometriosis may, in fact, have interstitial cystitis, and suggests approaches for appropriate diagnosis.
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Background: Chronic pelvic pain is a debilitating condition affecting quality of life. Endometriosis is one of the leading causes of CPP, but recent studies highlighted the role of interstitial cystitis/bladder pain syndrome (IC/PBS) in causing CPP. Only some studies addressed the coexistence between these two conditions, which seems more frequent than what is supposed, leading to diagnostic delays and unnecessary surgeries. This systematic review aimed to evaluate the estimate of the coexistence of endometriosis and IC/PBS. Methods: We performed a systematic review of the literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by “painful bladder syndrome”, “endometriosis”, “interstitial cystitis”, “bladder pain syndrome”. We performed a meta-analysis of the results. Results: Meta-analysis shows that the coexistence of endometriosis and IC/PBS in women with CPP ranges between 15,5-78,3%, which is higher than the prevalence of IC/PBS in the general population. Conclusions: Women with CPP need a multidisciplinary approach and a referral to centers with specific expertise. In cases of endometriosis unresponsive to treatment, other reasons for CPP need to be ruled out, above all in women not responsive to treatment.
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