NorthPoint Domain

Urology: AUA Issues First-Ever Interstitial Cystitis/Bladder Pain Syndrome Guidelines

Valid diagnosis, symptom control, and quality-of-life focus are key to effective treatment

The American Urological Association (AUA) issued clinical guidelines on the diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), which were published recently in The Journal of Urology. This is the first statement the organization has issued for the condition.

The guidelines are based on a systematic review of the published literature between January 1, 1983 and July 22, 2009. The authors note that the diagnosis of IC/BPS can be challenging because of the wide range of symptoms, physical exam findings, and clinical test results, which lead to a significant amount of misdiagnosis, under diagnosis, and diagnosis delays. The most effective approach for each patient, the authors write, is best determined by the clinician and the patient together. Assessment should include:

  • A basic assessment that includes a careful history and physical and laboratory examinations to document symptoms and exclude other conditions;
  • An assessment of baseline voiding symptoms and pain levels to evaluate later treatment; and
  • Cystoscopy and/or urodynamics when the diagnosis is in doubt.

The document also provides key clinical principles for first-line treatment of IC/BPS:

  • Treatment should begin with conservative therapies and be followed by less conservative therapies, only if they do not result in acceptable quality of life for the patient.
  • Clinicians should base the initial treatment type on symptom severity, his or her judgment, and patient preferences.
  • Clinicians should consider multiple, simultaneous treatments if it is in the best interest of the patient.
  • Clinicians should stop a treatment after it proves ineffective.
  • Clinicians should monitor and assess pain management for effectiveness because of its importance in patient quality of life. If pain is not managed effectively, clinicians should consider a multidisciplinary approach.
  • Clinicians should reconsider the IC/BPS diagnosis if multiple treatment approaches produce no improvement.
  • Clinicians should counsel patients about self-care practices, behavioral modifications, and coping techniques.

The authors also provide an algorithm that outlines a hierarchy of therapies including physical and medical therapies, as well as surgical options for IC/BPS. The following treatments are not recommended:

  • Long-term oral antibiotics;
  • Intravesical installation of bacillus Calmette-Guerin;
  • Intravesical installation of resiniferatoxin;
  • High-pressure, long-duration hydrodistension; or
  • Oral long-term glucocorticoid administration.

    • Source: Hanno PM, Burks DA, Clemens JQ, et al. 2011. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. The Journal of Urology 185:2162-2170.