AB098. Progress in diagnosis and treatment of bladder pain syndrome/interstitial cystitis

Objective: To provide an updated clinical framework for the definition, diagnosis and treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) according to the current available best evidence and advises a multimodal approach in its management.

Methods: A systematic literature review using the MEDLINE^® database (search dates 01/01/1975-07/04/2015) was conducted to identify peer-reviewed publications relevant to the aetiology, diagnosis and treatment of IC/BPS using ‘‘interstitial cystitis’’ or ‘‘bladder pain syndrome’’ as the keywords.

Results: A slightly modified definition of BPS/IC was developed by the International Consultation on Incontinence [2010]: an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptom(s) of more than 6 weeks duration, in the absence of infection or other identifiable causes. Although this widely accepted definition expands the patient population, the condition is still regarded as a diagnosis of exclusion. There have been no significant conclusive advances made in understanding either the etiology or pathogenesis of BPS/IC. Central neurological pathogenesis, genetic/familial, immunological, and infectious etiologies may be responsible for this puzzling and complex disorder. Patient education, self-care (diet modification) and stress management remain to be the first-line treatments. Intradetrusor botulinum toxin A injection, which was paired with cyclosporine as a fifth-line therapy in the initial guideline, was moved to a fourth-line therapy against BPS/IC based on the latest AUA guidelines. Intravesical DMSO/DMSO cocktail for BPS/ IC patients is reported to be associated with 65-90% response rates. Significant improvements in the mean VAS score, urinary urgency and bladder capacity are noted in BPS/IC patients receiving intravesical DMSO/DMSO cocktail treatment, although the long term effectiveness still needs to be evaluated.

Conclusions: As the science relevant to BPS/IC evolves and improves, the strategies presented will require amendment to remain consistent with the highest standards of care. The consideration of BPS/IC as a part of a generalized somatic disorder should open new pathways to the study of BPS/IC.

Keywords: Bladder pain syndrome/interstitial cystitis (BPS/IC); nomenclature; definition; diagnosis; treatment