Guideline issued for diagnosis, treatment of interstitial cystitis/bladder pain syndrome

The American Urological Association recently released its first-ever clinical guideline on diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS).

A guideline panel conducted a systematic review of the literature to develop its recommendations. Eighty-six studies were analyzed. Because insufficient evidence was found on diagnosis, these recommendations are based on clinical principles and expert opinion. The full text of the guideline is available online.

The guideline panel recommended that clinicians assessing patients for IC/BPS should perform a careful history, physical examination and laboratory examination to identify characteristic symptoms (such as pain, bladder pressure and discomfort, lack of infection, and marked urinary urgency and frequency) and to rule out such disorders as overactive bladder or, in men, chronic prostatitis. Baseline voiding symptoms and pain levels should also be measured. The value of cystoscopy and urodynamic studies is uncertain, although these tests may be useful to identify bladder abnormalities in symptomatic patients and to rule out bladder cancer or urethral diverticula, the panel said.

The panel's recommendations for overall management include the following:Type and level of initial treatment should be determined according to symptom severity, clinical judgment and patient preferences.Multiple concurrent treatments may be of benefit for some patients, according to baseline symptom measurement and regular assessment.Management of pain as well as its impact on quality of life should be regularly assessed.If symptoms do not improve after multiple treatments are attempted, the clinician should reconsider the diagnosis.

First-line treatment should include education about IC/BPS and its available treatments (including that no one treatment is effective in most patients and that multiple treatments are often needed), self-care and behavioral modification, and stress management techniques, the panel said. The guideline provides an algorithm that covers recommended first-line through sixth-line treatments. It also lists treatments that should not be offered, including long-term oral antibiotics and glucocorticoids. An executive summary of the guideline is scheduled for future publication in the Journal of Urology.