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AUA Guidelines for Interstitial Cystitis_Bladder Pain Syndrome To


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									AUA Guidelines for Interstitial
Cystitis/Bladder Pain Syndrome
To Be Highlighted
                  Dr. Philip Hanno                 tis/bladder pain syndrome for now.
                  Philadelphia, Pennsylvania       Because evidence-based data in the lit-
                                                   erature on the diagnosis and initial
                   The new AUA guide-              management of IC/BPS are insuffi-
                   line on Interstitial            cient, this section of the guideline was
                   Cystitis/Bladder Pain           based on expert opinion using a mod-
                   Syndrome (IC/BPS)               ified Delphi technique. This tech-
                   will be presented at            nique ensures that all points of view
                   the AUA 2010                    are considered when differences of
Plenary session in San Francisco. This             opinion exist and consensus is required.
project was first considered more than                 The syndrome was defined as “an
a decade ago but the process was aban-             unpleasant sensation (pain, pressure,
doned when it became apparent that                 discomfort) perceived to be related to
the existing knowledge base could not              the urinary bladder, associated with
support a guideline. As interest in the            lower urinary tract symptoms of more
syndrome has expanded markedly                     than 6 weeks duration, in the absence
across the globe and research efforts              of infection or other identifiable
have correspondingly increased, it was             causes” in accordance with the con-
determined that the time was right to              sensus of a meeting organized by the
revisit the issue.                                 Society for Urodynamics and Female
   The panel is comprised of experts               Urology.1 This basic assessment is
from the urological, gynecological,                designed to identify patients who ful-
neurological, nursing and patient advo-            fill the criteria of the definition, and
cacy fields, and includes Drs. David               should include a history, frequency/vol-
Burks, Quentin Clemens, Roger                      ume diary, physical examination, uri-
Dmochowski, Deborah Erickson,                      nalysis, urine culture, symptom
Mary Pat Fitzgerald, John Forrest,                 questionnaire and visual analog pain
Mikel Gray, Philip Hanno, Robert                   score. Cystoscopy, imaging studies,
Mayer Leroy Nyberg and Christopher                 urine cytology and urodynamics are
Payne; Ms. Barbara Gordon; and Ms.                 appropriate when the basic assessment
Diane Newman. This project is dis-                 reveals signs and symptoms suggestive
tinguished by the fact that the IC/BPS             of complicated IC/BPS to exclude con-
panel is the first to use several of the           ditions that may mimic the symptoms
newest processes instituted by the AUA             or to further evaluate abnormal find-
to maintain its reputation as the gold             ings such as hematuria.
standard source for practice guidelines.               Treatment is complex, and until
Details regarding these processes will             more definitively effective therapies
be presented immediately before the                are identified the treatment approach
IC/BPS guideline presentation on the               must be tailored to the specific symp-
Monday Plenary session by Dr. John                 toms of each patient to optimize qual-
Forrest, Chair of the AUA Practice                 ity of life. The panel strongly believes
Guidelines Committee (see page 000                 that urologists should consider part-
in this issue).                                    nering with other practitioners includ-
   With the ongoing debate about tax-              ing but by no means limited to physical
onomy and nomenclature in the                      therapists, pain specialists, gastroen-
urological and gynecological com-                  terologists and gynecologists who may
munities, the panel elected to refer to            have special expertise in treating
the syndrome as the interstitial cysti-

IC/BPS and often associated problems            to build in the coming years as our
such as irritable bowel syndrome or             database of information grows, and as
fibromyalgia. Treatment strategies              new areas of basic and clinical research
should proceed in a stepwise fashion            point the way toward improving our
using more conservative therapies first         care of these patients.
and implementing major surgical pro-               A diagnostic and treatment algo-
cedures only after other options have           rithm is being developed which will
been exhausted. Pain management is              be suitable for the wide, diverse, mul-
a paramount consideration through-              tispecialty audience that we expect to
out the course of the disease.                  consult this guideline. The overall
   The common orally administered               effort will be to simplify and stream-
treatment options include amitripty-            line the diagnostic and treatment
line, hydroxyzine, pentosanpolysulfate          approaches such that patients and cli-
and cimetidine. Intravesical treatment          nicians are confident that the diagno-
options include lidocaine, dimethyl-            sis is appropriate and the treatment
sulfoxide, heparin and cocktail com-            plan is evidence-based.
binations that may include a steroid as            The complete state-of-the-art lec-
well. Short-term hydrodistention with           ture on this topic will be given at this
the patient under anesthesia is con-            year’s AUA meeting in San Francisco,
sidered a second line therapeutic               California on Monday, May 31. ◆
option. Direct treatment of Hunner’s
lesion with fulguration, laser destruc-         1.   Hanno P and Dmochowski R: Status of
                                                      international consensus on interstitial cys-
tion or injection of triamcinolone is                 titis/bladder pain syndrome/painful blad-
one of the few treatment recommen-                    der syndrome: 2008 snapshot. Neurourol
dations of the panel.                                 Urodyn 2009; 28: 274-286.
   Those familiar with the IC/BPS lit-
erature will understand why the option          [runninghead] Presentation of
category dominates the treatment sec-           IC/BPS Guidelines
tion of the guidelines given the cur-
rent state of knowledge as revealed in
the literature. Nevertheless, this guide-
line will provide a foundation on which


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