What's new in the diagnosis and management of painful bladder syndrome/interstitial cystitis?
Painful bladder syndrome/interstitial cystitis (PBS/IC) is a controversial subject. Despite its many controversies, recent data on diagnostics show that cystoscopy and hydrodistension findings may not be sensitive or specific. Diagnosis is suggested primarily on the basis of history. Antiproliferative factor and Tamm-Horsfall protein are novel tests that may prove to be worthwhile pending future studies. Currently, there is no single diagnostic gold standard. Recent data on therapeutics show that, among oral therapies, amitriptyline and pentosan are efficacious. For best response, pentosan should be initiated early and used for a minimum of 6 months. Immune-modulating agents show promise but are limited by side effects. Intravesical alkalinized lidocaine with heparin may be effective for rapid symptom relief, pending results of prospective randomized trials. Intravesical botulinum toxin A, bacille Calmette-Guérin, and sacral neuromodulation may have a role in select patients.
Seth
Abhishek
A
Teichman
Joel M H
JM
D000639:Amitriptyline / Q000009:adverse effects / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use; D018856:Cystitis, Interstitial / Q000175:diagnosis* / Q000178:diet therapy / Q000188:drug therapy* / Q000652:urine; D003558:Cystoscopy / Q000592:standards; D006023:Glycoproteins / Q000652:urine; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use; D036341:Intercellular Signaling Peptides and Proteins; D009088:Mucoproteins / Q000652:urine; D010426:Pentosan Sulfuric Polyester / Q000009:adverse effects / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D014572:Urology / Q000639:trends*; D058949:Uromodulin
D018712:Analgesics, Non-Narcotic; D006023:Glycoproteins; D007155:Immunologic Factors; D036341:Intercellular Signaling Peptides and Proteins; D009088:Mucoproteins; C548612:UMOD protein, human; D058949:Uromodulin; C490708:antiproliferative factor APF, human; D000639:Amitriptyline; D010426:Pentosan Sulfuric Polyester