Clinical Guidelines For Interstitial Cystitis And Hypersensitive Bladder Syndrome

Main Category: Urology / Nephrology
Article Date: 16 Aug 2009 - 0:00 PDT

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UroToday.com - Asian Guidelines For Interstitial Cystitis and Hypersensitive Bladder Syndrome Published. The assumption that IC is very rare in Asia has limited the research and medical care of this condition. In recent years, the realization that IC is a common disease in Asian countries has lead to an increase in academic and social activities regarding IC.

Over the last few years, urologists from many Asian countries have been meeting on a regular basis to discuss the syndrome, in the hope of formulating guidelines. The last meeting occurred in Hualein, Taiwan in December 2008.

Drs. Yukio Homma, Tomohiuro Ueda, and Hikaru Tomoe from Japan, Drs. Alex Lin, Hann-Chorng Kuo, and Ming-Huei Lee from Taiwan, and Drs. Jeong Gu Lee, Duk Yoon Kim, and Kyu-Sung Lee from Korea and members of the committee have put together a comprehensive review of the subject and consensus guidelines based on their extensive discussions, a review of the literature, and review of results of the International Consultation of Interstitial Cystitis in Japan (ICICJ), International Consultation on Incontinence (Paris), and the European Society for the Study of Interstitial Cystitis guidelines. They have decided on a similar, but distinct interpretation of available data, and a unique set of guidelines for diagnosis and management. The full article is strongly recommended for those with an interest in this problem.

They define interstitial cystitis as "a disease of the urinary bladder diagnosed by three conditions: lower urinary tract symptoms, bladder pathology and exclusions of confusable diseases. The characteristic symptom complex is termed as "hypersensitive bladder syndrome (HBS), which is defined as bladder hypersensitivity, usually associated with urinary frequency, with or without bladder pain." Interstitial cystitis would thus seem to comprise a subset of the HBS population, characterized by true bladder pathology (further characterized as Hunner's lesion or bleeding after distention) and the absence of other diagnoses that could result in the symptom complex. HBS would seem to include anyone with the symptom complex, regardless of the specific cause (including overactive bladder), as this author would read it. Pain is not necessary for either diagnosis, and this is quite apart from European and American interpretations of the disorder.

In a novel section of the document, a superb discussion of Hunner's lesions is included as well as a shorthand for describing the cystoscopic findings.

Mandatory tests for the diagnosis of IC include clinical history, physical examination, and urinalysis. Recommended tests include urine culture and cytology, symptom and quality of life instruments, frequency-volume charts, residual urine measurement, psa, and cystoscopy with or without hydrodistention. Ultrasound imaging, urodynamics, CT imaging, intravesical potassium testing, and bladder biopsy are all optional.

In terms of treatment, the following recommendations are made:

1. When IC is highly likely, hydrodistention under anesthesia should be considered. It can be preceded by attempts at conservative therapy or can be the initial therapy. Conservative therapy includes behavior therapy, stress reduction, diet manipulation, and physical therapy.

2. If a Hunner's lesion is noted, it should be treated by coagulation or resection.

3. A variety of conservative therapies, oral therapies, or intravesical therapies are reasonable to try.

4. Cystectomy is the last resort.

There is quite a nice discussion of what led to the specific guidelines, and the article is highly recommended. With the guidelines of the American Urological Association expected next year, there will now be published documents from Europe, Asia, Japan, and the North America that will aid in the harmonization of diagnosis and therapy.

Homma Y, Ueda T, Tomoe H, Lin AT, Kuo HC, Lee MH, Lee JG, Kim DY, Lee KS
Int J Urol. 2009 Jun 22. Epub ahead of print.

Written by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com

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