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Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines

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Abstract

Introduction and hypothesis

Interstitial cystitis (IC) and bladder pain syndrome (BPS) are challenging and encompassing hypersensitivity disorders of the lower urinary tract. A variety of national and international guidelines have been published including guidance on nomenclature, definitions, etiopathology, diagnostics and treatment. A lack of universally established clinical guidance is apparent. The aim of this review is to evaluate key guidelines on this area of practice, identify variations, compare their recommendations and grade them using AGREE II.

Methods

Literature searches were performed using the PUBMED and CINAHL database from January 1, 1983, to December 1, 2018, referring to the search strategy of AUA. Ten national and international guidelines were included into the analysis. We assessed the guidelines with the updated AGREE II.

Results

Symptoms congruent in all guidelines are: pain, pressure, discomfort and frequency, urgency and nocturia. Urinalysis is a prerequisite for diagnostics, cystoscopy for most and urodynamics not part of the routine assessment. Treatment options are recommended stepwise. The highest level of evidence and consensus was identified for oral therapies. Nine guidelines had an overall quality score ≥ 50% and three scored ≥ 70% (AUA, GG, RCOG).

Conclusions

The guidelines are congruent in symptom reporting, quite congruent in diagnostics and vary to a high degree on treatment recommendations. The complexity of BPS and emerging evidence indicate the need for regular updating of the guidelines and a wider consensus.

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Authors and Affiliations

  1. Department of Gynecology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Janna Pape & Cornelia Betschart

  2. Department of Obstetrics and Gynecology, “San Bortolo” Hospital, Vicenza, Italy

    Gabriele Falconi

  3. Department of Obstetrics and Gynecology, Urogynaecology Division, University of Sao Paulo, Sao Paulo, Brazil

    Thais Regina De Mattos Lourenco

  4. Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK

    Stergios K. Doumouchtsis

  5. St George’s University of London, London, UK

    Stergios K. Doumouchtsis

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  1. Janna Pape
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Correspondence to Cornelia Betschart.

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The paper was presented as a short podium presentation at the IUGA 2018 in Wien

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Pape, J., Falconi, G., De Mattos Lourenco, T.R. et al. Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines. Int Urogynecol J 30, 1795–1805 (2019). https://doi.org/10.1007/s00192-019-03970-5

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