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Colaco M, Evans R. Current guidelines in the management of interstitial cystitis. Transl Androl Urol. 2015 Dec;4(6):677-83. doi: 10.3978/j.issn.2223-4683.2015.11.03.

This educational article helps explain the current American Urological Association (AUA) guidelines for interstitial cystitis (IC) and covers key research updates from even more up-to-date literature. The AUA guidelines are separated into six tiers of increasingly invasive treatments. The first step is to explore lifestyle modifications, while subsequent tiers involve physical therapy, drugs, and finally surgery for the most challenging cases that are not adequately treated by less invasive therapy. In practice, many patients will benefit from conservative measures, such as education, behavioral or dietary modification (for example, avoiding caffeine and spicy foods), and stress control. Physical therapy is also playing an increasingly important role, especially after studies that suggest it may provide some patients with a moderate or marked improvement in symptoms. If conservative therapy doesn’t work, the AUA guidelines say the next step could be oral therapy with agents such as amitriptyline, hydroxyzine/cimetidine, pentosan polysulfate, and cyclosporine A. If oral medications don’t work, the next step may be bladder instillation (delivery of a treatment into the bladder using a catheter); some of the most common of these therapies are DMSO, heparin, and lidocaine. Surgical procedures, such as cystoscopy with hydrodistention/fulguration of lesions, may be reserved for patients who don’t derive benefit from any of the above therapies. These surgical procedures are invasive but typically relatively benign. However, in the most extreme cases a more serious procedure, such as bladder removal or diversion, may be warranted. Since IC symptoms are quite variable from patient to patient, the authors recommend applying the AUA guidelines to tailor treatment to each specific situation.