Abstract
Interstitial Cystitis/Painful Bladder Syndrome is a controversial chronic disease characterized by pain, urgency and frequency. Patients with severe symptoms have a very miserable life. There is still no international consensus on its name, definition, investigations and management. American, European and Asian guidelines have been recently framed but differ on many important issues.
Presentations of IC/PBS patients are highly individual with the same or similar symptoms expressed differently. However, an important aspect of the symptoms is their relation to micturition. Since no internationally accepted standards exist for diagnosis and treatment, considerable variation is observed in the patient investigations. Investigations are divided between mandatory and optional. Sonography of kidney-ureter-bladder and urine culture are mandatory investigations as they rule out other pathologies. However, there is no consensus on important investigations such as cystoscopy. Some urologists believe painful bladder syndrome to be a clinical disease diagnosed on the basis of history and minimum investigations, while according to others cystoscopy confirms the disease by ruling out other potential causes of the symptoms and also helps in management decision-making.
No standard protocol exists for treatment. All the available treatments work on a few patients and it is difficult to decide which treatment is best for a given patient. This dilemma has led to a policy of staged treatment where various treatment modalities are applied to the patient one after other, starting with less invasive and progressing to more invasive. Some treatment modalities like intravesical Botox and neuro-modulation are for patients with refractory IC/PBS only.
Keywords: Guidelines, interstitial cystitis, mandatory investigations, painful bladder syndrome, refractory disease, staged treatment.
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