Guideline Update on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome

The American Urological Association (AUA) released a guideline update on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome with 26 updated guideline statements on diagnosis and approach to management.  Evidence levels assigned included a strength rating of A (high), B (moderate), or C (low) but many recommendations were based on Clinical Principles and Expert Opinion when insufficient evidence existed.


Treatment categories included behavioral/non-pharmacologic treatments with recommendations of self-care practices and behavioral modification and stress management.  Manual physical therapy for those presenting with pelvic floor tenderness is appropriate in this population. But clinicians should avoid pelvic floor muscle strengthening (Kegel) exercises.   The guideline recommended pharmacologic pain management that is similar to those approaches used in other chronic pain conditions.  Other oral medications are noted (amitriptyline, cimetidine, hydroxyzine, or pentosan polysulfate) with the warning of the potential risk for macular damage and vision-related injuries with pentosan polysulfate. The drug cyclosporine A may be offered to patients with Hunner lesions refractory to fulguration and/or triamcinolone. Also recommended are intravesical Instillation (DMSO, heparin, and/or lidocaine).  Although evidence strength was Grade C, the guideline panel recommended administration of intradetrusor onabotulinumtoxin A if other treatments have not provided adequate improvement in symptoms and quality of life noting patients must be willing to accept the possibility of the need for catheterization post-treatment.  Neuromodulation is also recommended if other treatments have failed.  Both of these had Grade C evidence. Major surgery is only recommended in select patients.  The guideline panel also listed treatments not recommended (intravesical BCG, high-pressure, long-duration hydrodistension, oral long-term glucocorticoids) because of the lack of efficacy and/or appear to be accompanied by unacceptable adverse event profiles. An algorithm is also available.

Written by: Diane Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practitioner (NP), Co-Director, Penn Center for Continence and Pelvic Health Director, Clinical Trials, Division of Urology, Adjunct Professor of Urology in Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

References:
Clemens JQ, Erickson DR, Varela NP et al: Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol 2022; https://doi.org/10.1097/JU.0000000000002756.

Published Date: July 2022

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