[Diagnostic approach to chronic bladder pain].
BACKGROUND
Painful bladder syndrome is defined as chronic pelvic pain present for more than 6 months, causing discomfort perceived as being related to the bladder and accompanied by a persistent and strong urge to urinate or urinary frequency. The purpose of this article is to review the diagnostic approach to painful bladder syndrome.


METHODS
A comprehensive review of the literature was performed by searching Pubmed for articles on the diagnostic approach to painful bladder syndrome.


RESULTS
Painful bladder syndrome was initially defined by pain related to bladder filling, but now refers to pain related to the bladder accompanied by urinary symptoms (persistent urge or frequency). The diagnosis of painful bladder syndrome is based on clinical interview and a bladder diary. Cystoscopy under general anaesthesia is an essential examination to confirm the diagnosis. Cystoscopy classically demonstrates glomerulations of the bladder mucosa and Hunner's ulcers and simultaneously allows bladder biopsies and bladder hydrodistension, which are the first steps in the management of painful bladder syndrome. The other complementary investigations: imaging, urodynamic assessment, laboratory work-up, cytology are not essential at diagnosis but are useful for the differential diagnosis, as painful bladder syndrome remains a diagnosis of exclusion.


CONCLUSIONS
The diagnosis of painful bladder syndrome is primarily clinical, but is confirmed by cystoscopy in the operating room under anaesthesia with bladder biopsies and a brief trial of hydrodistension.
Clinique urologique, centre fédératif de pelvi-périnéologie, hôpital Hôtel Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France. jrigaud@chu-nantes.fr
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Rigaud
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Delavierre
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Sibert
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JJ
Labat
D002908:Chronic Disease; D018856:Cystitis, Interstitial / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D010146:Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000175:diagnosis*