Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition whose diagnosis relies primarily on a structured process of exclusion. Defined as chronic pelvic pain, pressure, or discomfort perceived in relation to the bladder, accompanied by at least one urinary symptom, IC/BPS encompasses significant clinical and pathophysiological heterogeneity. A thorough medical history, targeted physical examination, and validated questionnaires such as the O'Leary-Sant score (ICSI/ICPI) form the foundation of initial evaluation. Patient phenotyping - distinguishing in particular the bladder-centric from the sensitization phenotype - is essential to guide both diagnostic and therapeutic strategies. Complementary investigations include a voiding diary, urine culture, imaging (ultrasound as first-line, CT scan and MRI as second-line modalities), and cystoscopy (preferably with hydrodistension under general anesthesia), which allows identification of Hunner's lesions, measurement of anatomical bladder capacity, and targeted biopsies. Urodynamic testing is reserved for cases of diagnostic uncertainty or associated voiding dysfunction. These recommendations aim to standardize the diagnostic approach in order to optimize individualized management in patients suffering from IC/BPS.
The French journal of urology. 2026 Jul 18 [Epub ahead of print]
F Meyer, C A Brandon, C Saussine, S Borojeni, P-O Bosset, S Campagne-Loiseau, J-N Cornu, L Donon, L Even, M Florin, F Hervé, J Klap, M A Perrouin Verbe, C Plassais, C Richard, A Vidart, S Lebdai, A Levesque, C Thuillier, B Peyronnet
Department of Urology, Hôpital Saint-Louis, AP-HP, Paris, France; Department of Urology, Hôpital Privé des Peupliers, groupe Ramsay, Paris, France. Electronic address: ., Department of Gynecology, Hôpital Paris-Saclay, Orsay, France., Department of Urology, Nouvel Hôpital Civil, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France., Department of Urology Clinique Saint Jean de Dieu, 2 rue Rousselet, Paris 75007, France., Department of Urology, Hôpital Foch, Suresnes, France., Department of Gynecology, CHU of Estaing, University of Clermont-Ferrand, Clermont-Ferrand, France., Department of Urology, CHU de Rouen, Rouen, France., Department of Urology, Clinique Belharra, groupe Ramsay, Bayonne, France., Department of Urology, Hôpital Privé Les Fleurs, Ollioules, France., Department of Radiology, Hôpital Tenon, AP-HP, Paris, France; Department of Radiology, Hôpital Privé des Peupliers, groupe Ramsay, Paris, France., Department of Urology, Ghent University Hospital, Ghent, Belgium., Department of Urology, Hôpital Privé Claude-Galien, groupe Ramsay, Quincy-sous-Sénart, France., Department of Urology, Centre Hospitalier Universitaire de Nantes, Nantes, France., Department of Urology, University of Rennes, Rennes, France., Department of Urology, CHU Angers, Angers, France - in the name of the CTMH (Committee on Male Lower Urinary Tract Symptoms), France., Pain Management Centre, CHU Nantes, Bd Jacques Monod, 44093 Nantes, UMR INSERM 1229, France., Department of Urology, CHU Grenoble-Alpes, La Tronche, France., Department of Urology, CHU de Rennes, Rennes, France.