Interstitial Cystitis:

Transcription

1 Diagnosis and Definition ESSIC approach Jørgen Nordling, chairman ESSIC Professor of Urology University of Copenhagen Denmark Interstitial Cystitis: A painful, potentially disabling, inflammatory disease of the urinary bladder of unknown etiology. Both NIDDK Criteria Bladder pain or urinary urgency; glomerulations or Hunner s ulcer Wein A et al.in Hanno et al.: Interstitial Cystitis.Springer-Verlag, Exclusions NIDDK Criteria Cystometric awake capacity > 350 ml. Using fill rate ml/min, absence of intense urge to void at 100 ml gas or 150 ml liquid. IVC on cystometry Awake frequency < 8/day No nocturia Duration < 9 mdr. Age < 18 years Cystitis (bakterial, chemical, TB, XRT) Prostatitis, Vaginitis Bladder, uterine, cervix, vaginal, urethral cancer Activ herpes Bladder or lower ureteral calculi Urethral diverticulum Results: The subcommittee found that in the 15 years since publication of the original NIDDK guidelines there has been no high hquality evidence to support the routine use of any diagnostic test in defining IC. Diagnosis and Definition: ESSIC Approach J. Nordling 1

2 COPENHAGEN WORKSHOP ON IC May June 2004 Copenhagen The European Society for the study of Interstitiel Cystitis / Painful Bladder syndrome (ESSIC) was founded. ESSIC 2005 Baden Austria and confusable diseases intestinal bacteria Diagnosis and Definition: ESSIC Approach J. Nordling 2

3 medical history eliminates intestinal bacteria physical examination eliminates intestinal bacteria dipstick analysis and cultures eliminate intestinal bacteria flowmetry, pressure-flow and ultrasound eliminate intestinal bacteria cystoscopy and biopsy if indicated eliminate intestinal bacteria intestinal bacteria Leaving Diagnosis and Definition: ESSIC Approach J. Nordling 3

4 Cystoscopy and morphology Because it is widely felt, that cystoscopy and bladder morphology provides important information, it was decided to make a classification including findings like glomerulations and Hunner s lesion during cystoscopy with hydrodistension and inflammatory or other changes at morphological investigation of bladder biopsies. symptoms such as increased daytime and nighttime frequency in the absence of CONSENSUS ON NOMENCLATURE that the diagnosis will be made on the basis of the symptom of pain related to the urinary bladder, accompanied by at least one other urinary symptom such as day-time and nighttime frequency, exclusion of confusable diseases as the cause of the symptoms and cystoscopy with hydrodistension and biopsy if indicated* CONSENSUS ON NOMENCLATURE that the diagnosis will be made on the basis of g the symptom of pain, pressure, discomfort related to the urinary bladder, accompanied by at least one other urinary symptom such as daytime and night-time frequency, exclusion of confusable diseases as the cause of the symptoms and cystoscopy with hydrodistension and biopsy if indicated* Diagnosis and Definition: ESSIC Approach J. Nordling 4

5 CONSENSUS ON NOMENCLATURE that the diagnosis will be made on the basis of the symptom of pain related to the urinary bladder, accompanied by at least one other urinary symptom such as day-time and night-time frequency, exclusion of confusable diseases as the cause of the symptoms and cystoscopy with hydrodistension and biopsy if indicated* IC: above with typical cystoscopic and CONSENSUS ON NOMENCLATURE that the diagnosis will be made on the basis of the symptom of pain related to the urinary bladder, accompanied by at least one other urinary symptom such as day-time and night-time frequency, exclusion of confusable diseases as the cause of the symptoms and cystoscopy with hydrodistension and biopsy if indicated* *If indicated to document the type of BPS. Taxonomy Painful Bladder Syndrome does not fit into the taxonomy of other pelvic pain syndromes like: Urethral pain syndrome Vulvar pain syndrome Etc. Taxonomy Painful Bladder Syndrome does not fit into the taxonomy of other pelvic pain syndromes like: Urethral pain syndrome Vulvar pain syndrome Etc. Interstitial Cystitis (IC) is a word so loaded with different interpretations, that it should be avoided. Diagnosis and Definition: ESSIC Approach J. Nordling 5

6 Taxonomy It was therefore decided to use the name Bladder Pain Syndrome in the future ESSIC definition 2008 Bladder Pain Syndrome (BPS) is diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or frequency. Confusable diseases as the cause of the symptoms must be excluded. The presence of other organ symptoms as well as cognitive, behavioral, emotional, and sexual symptoms should be addressed van de Merwe J. et al. European Urology 2008, 53: Thank You! Diagnosis and Definition: ESSIC Approach J. Nordling 6