Clinical guidelines for interstitial cystitis and hypersensitive bladder syndrome

Abstract

Abstract:A clinical guideline and algorism for interstitial cystitis and hypersensitive bladder syndrome has been developed by a group of East Asian urologists as a revised form of the Japanese guideline for interstitial cystitis. The guideline defines interstitial cystitis (IC) as a disease of the urinary bladder diagnosed by 3 requirements; 1) a characteristic complex of lower urinary tract symptoms, 2) bladder pathology such as Hunner's ulcer and bladder bleeding after overdistension, and 3) exclusions of confusable diseases. The characteristic symptom complex is termed as hypersensitive bladder syndrome (HBS), which is defined as bladder hypersensitivity, usually associated with urinary frequency, with or without bladder pain. For the definite diagnosis of IC, cytoscopy or hydrodistension is crutial; HBS is the diagnosis when IC is suspected but not confirmed by the 3 requirements. Numerous therapeutic options are available; however, most of them lack in high level of evidence, leaving a few as recommended therapies. Etiology of IC are multifactorial; the interaction among nervous, immune and endocrine factors forms a vicious cycle, provocating and maintaining inflammatory reactions in the bladder. The inclusion and efficacy criteria for clinical trials should be standardized to enhance the clinical research for this disabling disease, which has proved to be more prevalent than previously believed.

Hydrodistension der Harnblase zur Diagnostik und Therapie

“…Das japanische Interstitial Cystitis Guideline Committee beschreibt die Technik der Hydrodistension wie folgt: Unter Spinalanästhesie Füllung der Blase bis 80 cm H2O Druck unter ständiger zystoskopischer Kontrolle bis max 800 -1000 ml und Ablassen der Fül-lung unter optischer Kontrolle [6]. Die AUA Guidelines empfehlen eine Niedrigdruckdistension die 3 malig in dem Eingriff sequentiell wiederholt wird [7].…”

Effect of Supplementation With Hydrogen-rich Water in Patients With Interstitial Cystitis/Painful Bladder Syndrome

“…9,10 Previously, several trials were reported of L-arginine and quercetin that have similar anti-oxidant mechanism. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] L-arginine supplementation is used to counteract reduced production of nitric oxide (NO). NO is the oxidation product of L-arginine, a reaction catalyzed by NO synthase (NOS).…”

“…We recruited 30 patients at least 50 years old with IC/PBS, who fulfilled the diagnostic criteria for IC proposed by the clinical guideline for IC, 10,11 and obtained prospective approval of the trial protocol, informed consent forms, and other relevant documents from the Public Health Research institutional review board (Tokyo, Japan). This study was conducted in compliance with good clinical practice guidelines and the Declaration of Helsinki.…”

Editorial Comment from Dr Tomoe to Botulinum toxin type A injection for refractory interstitial cystitis: A randomized comparative study and predictors of treatment response

“…1 In addition to that, Homma et al proposed a concept, bladder hypersensitivity, and a cystoscopy for diagnosis of IC/BPS, which is also recommended by the European Society for the Study of Interstitial Cystitis. 2 Many urologists have noticed that some IC/BPS patients present different behavior towards the treatments. In the American Urological Association Guideline, 3 cystoscopy is the third-line treatment, but transurethral fulguration is recommended as a "should-be-performed" treatment for Hunner lesion.…”