Reinvestigation of Patients With a Diagnosis of Interstitial Cystitis: Common Things Are Sometimes Common

Abstract

While IC remains a diagnosis of exclusion, active exclusion of all possible causes of similar symptoms using a thorough investigative algorithm is imperative. Urodynamic investigation, together with a thorough history and physical examination, remains an important component of the diagnostic pathway.

Statistical Analysis of Symptoms, Endoscopy and Urothelial Morphology in 58 Female Bladder Pain Syndrome/Interstitial Cystitis Patients

“…Urodynamic examination serves to exclude detrusor hyperactivity, or possibly other lower urinary tract dysfunctions. Some authors recommend measuring cystometric capacity by application of solution of KCl into the bladder (the so-called modified potassium test) [25][26][27] . This test is recommended for selection of patients with a more probable response to intravesical therapy [28] .…”

Japanese guideline for diagnosis and treatment of interstitial cystitis

“…Pain syndromes would be appropriate to refer to symptom syndromes of IC or IC‐like conditions, because bladder and/or pelvic pains are characteristic to those conditions. However, they are unacceptable, because a significant proportion of IC patients are without pain and these patients would remain undiagnosed out of the scope of the pain syndromes 13 . The term ‘IC/PBS’ inclusively covers diverse patient populations from those meeting NIDDK criteria to those only having PBS.…”

“…Pain may be felt in the perineum, in the pelvis, or during sexual intercourse. However, it should be noted that a substantial portion of patients complain of no pain 66–69 . A more specific symptom would be bladder discomfort at an early phase of bladder filling (hypersensitivity), which is not urgency or sudden compelling desire to void (the key symptom of overactive bladder).…”

Urologic Chronic Pelvic Pain Syndrome

“…49 Urodynamics A full cystometrogram may need to be performed to define the patient's bladder sensation, capacity, and compliance, and to rule out detrusor overactivity, significant hypocompliance, or bladder outlet obstruction. 46 A small study comparing overactive bladder (OAB) patients with those diagnosed with PBS showed that the urodynamic characteristics of the patients with PBS were significantly different from those of the patients with OAB. The PBS/IC group showed a greater premature filling sensation and decreased bladder capacity compared to the OAB group and were able to handle smaller urine volumes.…”

“…Any suspicious lesion should be biopsied. 46,47 In Europe, biopsy findings that are accepted as positive signs of BPS are inflammatory infiltrates, granulation tissue, detrusor mastocytosis, or intrafascicular fibrosis. 49 Urodynamics A full cystometrogram may need to be performed to define the patient's bladder sensation, capacity, and compliance, and to rule out detrusor overactivity, significant hypocompliance, or bladder outlet obstruction.…”