LINTHICUM, MD, February 28, 2011— The American Urological Association (AUA) released today a new clinical Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS), a potentially devastating condition that impacts not only a patient’s physical function, but also their psychosocial function and quality of life. This is the first time the AUA has issued such guidance to help aid physicians in diagnosing and treating patients who present with symptoms of IC/BPS. A complete Executive Summary for the guideline will be published in an upcoming issue of The Journal of Urology®. A Webinar about the Guideline is forthcoming and will be available online at www.AUAnet.org.
Though the science relevant to IC/BPS is continually improving and evolving, it can be challenging to diagnose and frustrating to treat this complicated condition. This new Guideline is designed to present a clinical strategy for physicians, and the Guideline panel notes that the most effective approach for a specific case should be determined by the individual patient and their clinician.
Panel experts recommend the following in assessing both women and men for the condition:
- A full basic assessment, including a careful history, physical examination and laboratory examination to identify characteristic IC/BPS symptoms (including sensations of pain, pressure and discomfort perceived by the patient to be related to the bladder, absence of infection, as well as marked urinary urgency and frequency) and rule out confusable disorders (such as overactive bladder or, specifically in men, chronic prostatitis).
- Measurements of baseline voiding symptoms and pain levels (to which subsequent levels may be compared to measure treatment efficacy).
- The consideration of cystoscopy and/or urodynamic studies to better assess complicated presentations or to confirm a diagnosis when assessment results are in doubt. While there are no existing cystocopic or urodynamic findings specific for IC/BPS, these tests can be valuable in identifying lesions or alterations (Hunner’s lesions) in the bladder in patients with symptoms, and in ruling out other entities such as bladder cancer or urethral diverticula.
Currently there is no cure for IC/BPS and, at this time, no one single treatment works well over time for a majority of affected patients. The Guideline Panel recommends that, in order to care for IC/BPS patients (particularly those with complicated presentations), such care should be coordinated between the urologist and other clinicians, potentially including primary care providers, nurse practitioners, registered dieticians, physical therapists, pain specialists, gastroenterologists and/or gynecologists to best guide and execute treatment.
The Panel outlines the key clinical principles for first-line treatment of IC/BPS:
- Strategies should start with the most conservative treatments first before moving to less conservative therapies.
- Initial treatment type and level should be related to symptom severity, clinical judgment and patient preferences. Patients should be counseled with regard to reasonable expectations for treatment outcomes.
- Some patients may benefit from multiple, concurrent treatments; baseline symptom measurement and regular assessment is critical to document the efficacy of combined vs. single treatments.
- Ineffective treatments should be stopped once a clinically meaningful interval has elapsed.
- Pain management and its impact on a patient’s quality of life should be regularly assessed and considered.
- If no improvement in symptoms occurs after multiple treatment approaches, the diagnosis should be reconsidered.
- Patients should be counseled on how certain self-care practices, behavioral modifications and coping techniques may help manage their IC/BPS symptoms.
The Guideline also provides a helpful algorithm which outlines a hierarchy of therapies including physical and medical therapies as well as surgical options for IC/BPS. The following treatments are not recommended in the treatment of IC/BPS: long-term oral antibiotics; intravesical instillation of bacillus Calmette-Guerin (BCG) or resiniferatoxin (RTX); 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 Philip Hanno, MD, who chaired the multi-disciplinary Panel that developed the Guideline. “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 full text of the evidence-based Guideline is available online at www.AUAnet.org.
Members of the Interstitial Cystitis Guideline Panel: Philip M. Hanno, MD (chair); David Allen Burks, MD; J. Quentin Clemens, MD, MSCI; Roger R. Dmochowski, MD; Deborah Erickson, MD; Mary Pat FitzGerald, MD; John B. Forrest, MD; Barbara Gordon, MBA, RD; Mikel Gray, PhD; Robert Dale Mayer, MD; Diane Newman, MSN, ANP-BC, CRNP; Leroy Nyberg Jr., MD, PhD; Christopher K. Payne, MD; and Ursula Wesselmann MD, PhD.
For more information on this Guideline or to schedule an interview with Dr. Hanno, please contact Wendy Isett at 410-689-3932 or communications@AUAnet.org.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 16,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
Wendy Isett, AUA