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Interstitial cystitis/bladder pain syndrome: diagnosis and management

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Abstract

Introduction and hypothesis

The bladder pain syndrome (BPS) is a spectrum of urological symptoms characterised by bladder pain with typical cystoscopic features. Diagnosis and management of this syndrome may be difficult. There is no evidence-based management approach for the diagnosis or treatment of BPS. The objective of this study was to critically review and summarise the evidence relating to the diagnosis and treatment of the bladder pain syndrome.

Methods

A review of published data on the diagnosis and treatment of the BPS was performed. Our search was limited to English-language articles, on the “diagnosis”, and “management” or “treatment” of “interstitial cystitis” and the “bladder pain syndrome” in “humans.”

Results

Frequency, urgency and pain on bladder filling are the most common symptoms of BPS. All urodynamic volumes are reduced in patients with BPS. Associated conditions include psychological distress, depression, history of sexual assault, irritable bowel syndrome and fibromyalgia. Cystoscopy remains the test for definitive diagnosis, with visualisation of haemorrhage on cystoreduction. A multidisciplinary treatment approach is essential in the management of this condition. Orally administered amitriptyline is an efficacious medical treatment for BPS. Intravesical hyaluronic acid and local anaesthetic, with/without hydrodistension are among new treatment strategies. Sacral or pudendal neuromodulation is effective, minimally invasive and safe. Surgery is reserved for refractory cases.

Conclusions

There remains a paucity of evidence for the diagnosis and treatment of BPS. We encountered significant heterogeneity in the assessment of symptoms, duration of treatment and follow up of patients in our literature review.

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Abbreviations

BPS:

Bladder pain syndrome

IC:

Interstitial cystitis

PBS:

Painful bladder syndrome

GP:

General practitioner

OAB:

Overactive bladder

IBS:

Irritable bowel syndrome

QoL:

Quality of life

GAG:

Glycosaminoglycan

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Acknowledgements

The authors would like to acknowledge Dr Danielle O’Leary and Dr Athanasios Didangelos for their help in the preparation and editing of this manuscript.

Funding for project

There was no funding required for completion of this review.

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Authors and Affiliations

  1. Department of Urogynaecology, Cork University Maternity Hospital, Wilton, Ireland

    I. Offiah & B. A. O’Reilly

  2. Neurorestoration Group, Wolfson CARD, King’s College London, London, SE1 1UL, UK

    S. B. McMahon

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  1. I. Offiah
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Correspondence to I. Offiah.

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Offiah, I., McMahon, S.B. & O’Reilly, B.A. Interstitial cystitis/bladder pain syndrome: diagnosis and management. Int Urogynecol J 24, 1243–1256 (2013). https://doi.org/10.1007/s00192-013-2057-3

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  • DOI: https://doi.org/10.1007/s00192-013-2057-3

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