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Interstitial cystitis/bladder pain syndrome

Key sources
The following summarized guidelines for the evaluation and management of interstitial cystitis/bladder pain syndrome are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022), the American Urological Association (AUA 2022), and the Royal College of Obstetricians and Gynaecologists (RCOG 2017).
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Guidelines

1.Screening and diagnosis

Diagnosis: as per EAU 2022 guidelines, diagnose patients with symptoms according to the European Association of Urology definition, after primary exclusion of specific diseases, with primary BPS by subtype and phenotype.
A
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2.Classification and risk stratification

Severity assessment: as per EAU 2022 guidelines, use a validated symptom and QoL scoring instrument for initial assessment and follow-up.
A

3.Diagnostic investigations

Initial assessment
As per AUA 2022 guidelines:
Elicit a careful history, perform a physical examination, and obtain laboratory tests to document symptoms and signs characterizing IC/BPS, and rule out other disorders.
B
Elicit baseline voiding symptoms and pain levels to assess subsequent treatment effects.
B

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4.Diagnostic procedures

Cystoscopy
As per AUA 2022 guidelines:
Consider performing cystoscopy when the diagnosis is in doubt, but not necessarily for making the diagnosis in uncomplicated presentations.
E
Perform cystoscopy in patients with suspected Hunner lesions.
E

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5.Medical management

General principles
As per AUA 2022 guidelines:
Make treatment decisions after shared decision-making with the patient informed of the risks, potential benefits, and alternatives.
Offer nonsurgical options as initial treatment, except for patients with Hunner lesions.
E

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  • Pharmacotherapy

6.Nonpharmacologic interventions

Self-care and behavioral modifications: as per AUA 2022 guidelines, discuss and implement self-care practices and behavioral modifications as feasible to improve symptoms in patients with IC/BPS.
B

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  • Dietary modifications

  • Physical therapy

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7.Therapeutic procedures

Bladder hydrodistention
As per AUA 2022 guidelines:
Consider performing cystoscopy under anesthesia with short-duration, low-pressure hydrodistension as a treatment option in patients with IC/BPS.
C
Do not perform high-pressure, long-duration hydrodistension in patients with IC/BPS.
D

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8.Surgical interventions

Transurethral fulguration and resection: as per AUA 2022 guidelines, perform fulguration with electrocautery and/or submucosal injection of triamcinolone in patients presenting with Hunner's lesions.
B

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9.Specific circumstances

Pregnant patients: counsel female patients that the effect of pregnancy on the severity of BPS symptoms can be variable.
B
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10.Patient education

General counseling: as per AUA 2022 guidelines, educate patients with IC/BPS regarding:
normal bladder function
what is known and not known about IC/BPS
relative risks and benefits of available treatments
the fact that no single treatment has been found effective for the majority of patients
the fact that acceptable symptom control may require trials of multiple therapeutic options, including combination therapy.
B

11.Follow-up and surveillance

Assessment of treatment response
As per AUA 2022 guidelines:
Reassess the efficacy of treatment periodically and discontinue ineffective treatments.
B
Reconsider the diagnosis of IC/BPS if no improvement occurs after multiple treatment approaches.
B