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S2k-Leitlinie Diagnostik und Therapie der interstitiellen Zystitis (IC/BPS)

Diskussion der aktuellen Leitlinie anhand eines Fallbeispiels

S2K guideline on the diagnosis and treatment of interstitial cystitis (IC/BPS)

Discussion of the current guideline using a case study

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Zusammenfassung

Die interstitielle Zystitis (IC) ist eine chronisch-progrediente Erkrankung, die für die Betroffenen und den behandelnden Therapeuten oft schwierig und unbefriedigend verläuft. Die Behandlung sollte daher umfassend, interdisziplinär, multimodal und unter Berücksichtigung des biopsychosozialen Modells erfolgen. Die Leitlinie bildet einen roten Faden durch die vielfältigen diagnostischen und therapeutischen Möglichkeiten und liefert umfangreiche Hintergrundinformationen zu Definition, Epidemiologie und Ätiopathogenese dieser seltenen Erkrankung. Praxis und Theorie/Leitlinie sind jedoch different. Eine Anpassung an den Einzelfall ist daher notwendig und explizit erwünscht. Die Leitlinie soll daher als Ideengeber für Kollegen dienen, um sich eigene für Ihre Praxis passende Standards zusammenzustellen. Einerseits werden im klinischen Alltag erprobte Therapieansätze „aus der Praxis für die Praxis“ weitergegeben, andererseits sollte die häufig fehlende Evidenz auch kritisch betrachtet werden. Weitere Studien, möglichst auch multizentrisch, speziell ausgelegt auf verschiedene Aspekte der IC wären wünschenswert. Zur bestmöglichen Behandlung der Betroffenen mit IC ist eine enge Vernetzung zwischen niedergelassenen Therapeuten und speziellen Zentren unumgänglich. Die Leitlinie soll dabei Grenzen aufzeigen, was in Praxen und Ambulanzen geleistet werden kann und eine Hilfestellung bieten, ab wann Betroffene in ein „Zentrum für Interstitielle Cystitis und Beckenschmerz“ weitergeleitet werden sollen. Insgesamt konnte durch die Leitlinie eine bessere Präsenz dieser seltenen Erkrankung bei den Kollegen und Kolleginnen erreicht werden. Eine umfassende Ergänzung, Aktualisierung und weitere Untermauerung mit dem Stand der aktuellen Forschung ist somit wünschenswert.

Abstract

IC/BPS is a chronic progressive disorder that is often difficult and unsatisfactory for the person affected and the treating therapist. Treatment should therefore be comprehensive, interdisciplinary, multimodal and take into account the biopsychosocial model. The guideline forms a thread through the diverse diagnostic and therapeutic options and provides extensive background information on the definition, epidemiology and aetiopathogenesis of this rare disease. However, practice and theory/guideline are different. Adaptation to the individual case is therefore necessary and explicitly desired. The guideline should therefore serve as a source of ideas for colleagues to compile their own standards suitable for their practice. On the one hand, therapy approaches that have been tried and tested in everyday clinical practice are passed on. On the other hand, the frequent lack of evidence should also be viewed critically. Further studies, if possible multi-centre, specifically designed for different aspects of IC/BPS would be desirable. Close networking between therapists in private practice and special centres is essential for the best possible treatment of people with IC/BPS. The guideline is intended to show the limits of what can be done in practices and outpatient clinics and to provide guidance on when patients should be referred to a “Centre for Interstitial Cystitis and Pelvic Pain”. Overall, the guideline has improved the presence of this rare disease among colleagues. A comprehensive supplement, update and further substantiation with the state of current research is thus desirable.

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Authors and Affiliations

  1. Städtisches Klinikum Lüneburg gGmbH, Urologische Klinik, Zentrum für Interstitielle Zystitis und Beckenschmerz, Bögelstr. 1, 21339, Lüneburg, Deutschland

    J. Tolle & B. T. Kaftan

  2. Klinikum Weiden, Klinik für Urologie, Andrologie und Kinderurologie, Zentrum für Interstitielle Zystitis und Beckenschmerz, Kliniken Nordoberpfalz AG, Weiden, Deutschland

    Th. Bschleipfer

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Correspondence to J. Tolle.

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Interessenkonflikt

Th. Bschleipfer gibt Berater- und Vortragstätigkeiten für Dr. R. Pfleger von 2017 bis heute, Astellas von 2017 bis 2019, Apogepha in 2018, Ferring in 2019 und Grünenthal von 2017 bis 2019 an. B.T. Kaftan ist Auditor der Onkozert GmbH, Mitglied der DGU, DKG, BDU, ICS, ICA und EAU und gibt Beratertätigkeiten für Dr. Pfleger, Uromed und Bene Pharma an. J. Tolle ist Mitglied der DGU und GESRU.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Tolle, J., Kaftan, B.T. & Bschleipfer, T. S2k-Leitlinie Diagnostik und Therapie der interstitiellen Zystitis (IC/BPS). Urologe 61, 250–259 (2022). https://doi.org/10.1007/s00120-021-01753-9

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