Diagnosis and Treatment of Interstitial Cystitis/ Bladder Pain Syndrome (IC/BPS) – A Phenotype Driven Approach_On-Demand-PPT Handout_Diagnosis and Treatment of IC/BPS

PPT Handout_Diagnosis and Treatment of IC/BPS – A Phenotype Driven Approach

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The document discusses the diagnosis and treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) using a phenotype-driven approach. The updated 2022 AUA (American Urological Association) guideline on the diagnosis and treatment of IC/BPS introduces some notable changes. The diagnosis remains symptom-based, characterized by an unpleasant sensation related to the urinary bladder, associated with lower urinary tract symptoms lasting more than six weeks, without infection or other identifiable causes. The guideline recommends ruling out other confusable diseases and suggests cystoscopy for patients at risk of having Hunner lesions, such as men or women over the age of 50, those who have failed conventional therapies but have not had a cystoscopy before, or those with abnormal findings from previous cystoscopies.<br /><br />Regarding treatment, the guideline suggests counseling patients considering pentosan polysulfate on the potential risk of macular damage and vision-related injuries. For patients with Hunner lesions, fulguration with electrocautery and/or injection of triamcinolone is recommended. Pelvic floor physical therapy techniques should be offered to patients with pelvic floor tenderness, while pelvic floor strengthening exercises like Kegel exercises should be avoided. Intravesical treatments such as DMSO, heparin, and lidocaine may be administered, and a local anesthetic challenge can help localize the source of pain to the bladder. The document also highlights the importance of recognizing different phenotypes within the IC/BPS population, such as bladder-centric and centralized pain phenotypes, and tailoring treatments accordingly. Overall, a phenotype-driven approach can potentially improve the efficacy of treatments for IC/BPS.

Keywords

IC/BPS

phenotype-driven approach

diagnosis

treatment

2022 AUA guideline

Hunner lesions

cystoscopy

fulguration

pelvic floor physical therapy

intravesical treatments