The American Urological Association (AUA) has released the first clinical guidelines for diagnosing and treating interstitial cystitis/bladder pain syndrome (IC/BPS).
The guidelines recommend a full basic assessment, including a careful history, physical examination, and laboratory measures to identify IC/BPS symptoms, such as pain, pressure, and discomfort; measurements of baseline voiding symptoms and pain levels; consideration of cystoscopy and/or urodynamic studies to better assess complicated presentations or to confirm a diagnosis when assessment results are in doubt, according to an AUA press release.
With respect to first-line treatment, the guidelines recommend that clinicians begin with the most conservative treatments before moving to less conservative approaches. Symptom severity, clinical judgment, and patient preferences should guide initial treatment type. Patients should be counseled with regard to reasonable expectations for treatment outcomes.
Some patients may benefit from multiple, concurrent treatments, the guidelines state. Baseline symptom measurements and regular assessments are critical to document the efficacy of combined versus single treatments. Clinicians should reconsider the diagnosis if patients experience no improvement in symptoms after multiple treatment approaches.
The guidelines do not recommend the use of long-term oral antibiotic therapy; intravesical instillation of bacillus Calmette-Guérin or resininferatoxin; high-pressure, long-duration hydrodistension; or oral long-term glucocorticoid administration.
“IC/BPS affects a significant number of patients whose quality of life is severely diminished by this complicated, frustrating condition,” said panel chair Philip Hanno, MD, Professor of Urology in Surgery at the University of Pennsylvania in Philadelphia. “This population has historically been both under-recognized and underserved, and it is our hope that this guideline provides physicians with a much-needed roadmap to help treat these patients.”
The guidelines will appear in an upcoming issue of The Journal of Urology.