Source: The following summary is from the July 2009 newsletter of the International Painful Bladder Foundation (IPBF, www.painful-bladder.org).
The committee has decided on the following definitions for their guideline: We define interstitial cystitis (IC) as a disease of the urinary bladder diagnosed by three conditions:
- lower urinary tract symptoms
- bladder pathology
- exclusion 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. Explanatory note:
- lower urinary tract symptoms such as bladder hypersensitivity, urinary frequency, bladder
- discomfort and bladder pain;
- bladder pathology such as Hunner’s ulcer and mucosal bleeding after over-distension;
- exclusion of confusable diseases such as infection, malignancy and calculi of the urinary tract.
This East Asian Committee is therefore proposing a new symptom syndrome: Hypersensitive Bladder Syndrome (HBS). This would be a clinical entity that is more inclusive than pain syndromes alone since it incorporates patients with and without pain. The authors explain that HBS can be used as a descriptive term for the symptom complex, or as a diagnostic name for the condition in a patient suspected of having IC but who has not fulfilled all the requirements for the diagnosis of IC as given above.
Cystoscopy is considered essential for the diagnosis of Interstitial Cystitis. Without it, the diagnosis remains the symptom syndrome HBS. The authors also state that because of the importance of the cystoscopic findings, they should be recorded before and after distension in a standardized way.
In this guideline, bladder biopsy is not considered to be an essential part of diagnosis. When performed, however, it is advisable to do it after hydrodistension to avoid the risk of bladder rupture, even though histological findings may be affected by this procedure.
The authors are of the opinion that it would be unrealistic in a clinical setting to consider discomfort and pressure to be a type of pain. Patients do not consider discomfort and pressure to be the same as pain. If pain is considered to embrace discomfort and pressure, many patients not complaining of pain would remain undiagnosed.
The authors interestingly draw a distinction between two types of Hunner’s ulcer: the Hunner’s ulcer and the Atypical Hunner’s ulcer. The committee also calls for standardisation of inclusion and efficacy criteria for clinical trials to improve research.
A useful clinical algorithm is included in this very detailed guideline aimed at guiding care providers in the diagnosis and treatment of patients with hypersensitive bladder syndrome. This practical and realistic guideline is targeted at all healthcare professionals involved in the diagnosis and treatment of IC and IC-related conditions.
Posted July 24, 2009