Page 1 - Diagnosis and treatment of interstitial cystitis/bladder pain syndrome

guideline

CUA guideline: Diagnosis and treatment of interstitial cystitis/

bladder pain syndrome

Consensus panel co-chairs: Ashley Cox, MD, MSc, FRCSC; Nicole Golda, MD, MSc, FRCSC;
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2,5
Genevieve Nadeau, MD, MSc, FRCSC 3
Consensus panel members: J. Curtis Nickel, MD, FRCSC; Lesley Carr, MD, FRCSC;
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Jacques Corcos, MD, FRCSC; Joel Teichman, MD, FRCSC 7
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1 Department of Urology, Dalhousie University, Halifax, NS, Canada; Department of Urology, North “The complaint of suprapubic pain, related to bladder filling
York General Hospital, Toronto, ON, Canada; CHU de Québec, Division of Urology, Quebec, QC, accompanied by other symptoms, such as increased daytime
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Canada; Queens University, Kingston, ON, Canada; Department of Surgery, University of Toronto, and nighttime frequency, in the absence of proven urinary
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Toronto, ON, Canada; McGill University, Montreal, QC, Canada; University of British Columbia, infection or other obvious pathology” of the lower urinary
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Vancouver, BC, Canada
tract. Subsequent to this definition, some used IC to reflect
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patients who meet the classic NIDDK criteria and PBS to reflect
those with identical symptoms, but who did not undergo formal
Cite as: Can Urol Assoc J 2016;10(5-6):E136-55. http://dx.doi.org/10.5489/cuaj.3786
Published online May 12, 2016. hydrodistension or did not meet all of the NIDDK criteria.
Due to similarities with IC/PBS and other chronic pain
syndromes, the European Society for the Study of IC/BPS
Methodology (ESSIC) provided a new definition, which was more descrip-
tive of the clinical syndrome and the underlying pathol-
ogy. This expanded term, bladder pain syndrome (BPS),

The following guidelines were based on MEDLINE and describes all patients with “chronic pelvic pain, pressure,
PUBMED searches of English language literature, in addi- or discomfort, perceived to be related to the urinary bladder
tion to consensus conference proceedings. Levels of evi- accompanied by at least one other urinary symptom: persis-
dence and grades of recommendation were assigned for tent urgency or urinary frequency.” To include all patients
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each investigation and treatment, as per the modified Oxford with bladder pain, in 2010, the International Consultation
Centre for Evidence-Based Medicine grading system. Where of Incontinence accepted this revised definition. In 2009,
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the literature was inconsistent or scarce, a consensus expert the Society for Urodynamics and Female Urology (SUFU)
opinion was generated to provide treatment guidelines. defined the term IC/BPS as “an unpleasant sensation (pain,
pressure, discomfort) perceived to be related to the urinary
Introduction bladder, associated with lower urinary tract symptoms for
more than six weeks duration, in the absence of infection
or other identifiable causes.” This is the definition used by
Terminology the American Urological Association (AUA) in the most
recent guidelines on IC/BPS. This is the definition that will
Much confusion regarding the diagnosis of this clinical syn- be referred to for the purpose of this guideline.
drome is due to many changes in definition and nomencla- The corresponding French terminology is cystite inter-
ture since its first description in 1887 by Skene. The condi- stitielle, cystalgie à urine claire, or cystalgie abacterienne.
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tion classically known as interstitial cystitis (IC) was reserved
for patients with typical cystoscopic findings, such as glo- Epidemiology
merulations, or the classic bladder wall Hunner’s ulcer. 2
Up until 2002, the National Institute for Diabetes and There is wide variation in reported incidence and prevalence
Digestive and Kidney Diseases (NIDDK) criteria were used of IC/BPS depending on the criteria used for diagnosis. Current
to define IC. However, it was recognized that the NIDDK studies estimate that between 2.7 and 6.5% of American women
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criteria were designed to delineate a homogeneous popula- have symptoms consistent with a diagnosis of IC/BPS. The
tion for research trials and were overly restrictive for use in broad range in incidence depends on whether highly sensitive
routine clinical practice. Therefore, in 2002, the International or highly specific defining criteria are used — further highlight-
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Continence Society defined painful bladder syndrome (PBS) as: ing the need for a standardized diagnostic algorithm.
E136 CUAJ • May-June 2016 • Volume 10, Issues 5-6
© 2016 Canadian Urological Association