Abstract
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.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Pool TL, Rives HF: Interstitial cystitis: treatment with silver nitrate. J Urol 1944, 51:520–525.
Bojar S, Reich P: Psychosomatic aspects of urology. In Campell’s Urology, edn 4. Edited by Harrison JH, Gittes RF, Perlmutter AD, et al. Philadelphia: Saunders; 1979:1906–1909.
Slobodov G, Feloney M, Gran C, et al.: Abnormal expression of molecular markers for bladder impermeability and differentiation in the urothelium of patients with interstitial cystitis. J Urol 2004, 171:1554–1558.
Parsons CL, Greenberger M, Gabal L, et al.: The role of urinary potassium in the pathogenesis and diagnosis of interstitial cystitis. J Urol 1998, 159:1862–1867.
Teichman JMH, Moldwin R: The role of the bladder surface in interstitial cystitis/painful bladder syndrome. Can J Urol 2007, 14:3599–3607.
Letourneau R, Sant GR, el-Mansoury M, et al.: Activation of bladder mast cells in interstitial cystitis. Int J Tissue React 1992, 14:307–312.
Tomaszewski JE, Landis JR, Russack V, et al.: Biopsy features are associated with primary symptoms in interstitial cystitis: results from the Interstitial Cystitis Database Study. Urology 2001, 57:67–81.
Hand JR: Interstitial cystitis: report of 223 cases (204 women and 19 men). J Urol 1949, 61:291–310.
Saban MR, Nguyen NB, Hammond TG, Sabar R: Gene expression profiling of mouse bladder inflammatory responses to LPS, substance P, and antigen-stimulation. Am J Pathol 2002, 160:2095–2110.
Bjorling DE, Beckman M, Saban R: Neurogenic inflammation of the bladder. Adv Exp Med Biol 2003, 539:551–583.
Parsons CL, Stein P, Zupkas P, et al.: Defective Tamm-Horsfall protein in patients with interstitial cystitis. J Urol 2007, 178:2665–2670.
Peters KM, Kalinowski SE, Carrico DJ, et al.: Fact or fiction—is abuse prevalent in patients with interstitial cystitis? Results from a community survey and clinic population. J Urol 2007, 178:891–895.
Nazif O, Teichman JMH, Gebhart GF: Neural upregulation in interstitial cystitis. Urology 2007, 69:24–33.
Driscoll AM, Teichman JMH: How do interstitial cystitis patients present? J Urol 2001, 166:2118–2120.
Messing EM, Stamey TA: Interstitial cystitis: early diagnosis, pathology, and treatment. Urology 1978, 12:381–392.
Gillenwater JY, Wein AJ: Summary of the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases Workshop on Interstitial Cystitis. J Urol 1988, 140:203–206.
Hanno PM, Landis JR, Matthews-Cook Y, et al.: The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database study. J Urol 1999, 161:553–557.
Warren JW, Brown J, Tracy JK, et al.: Evidence-based criteria for pain of interstitial cystitis/painful bladder syndrome in women. Urology 2008, 71:444–448.
Mattox TF: Interstitial cystitis in adolescents and children: a review. J Pediatr Adolesc Gynecol. 2004, 17:7–11.
Payne CK, Terai A, Komatsu K: Research criteria versus clinical criteria for interstitial cystitis. Int J Urol 2003, 10:S7–S10.
Waxman JA, Sulak PJ, Kuehl TJ: Cystoscopic findings consistent with interstitial cystitis in normal women undergoing tubal ligation. J Urol 1998, 160:1663–1667.
Denson MA, Griebling TL, Cohen MB, et al.: Comparison of cystoscopic and histologic findings in patients with suspected interstitial cystitis. J Urol 2001, 164:1908–1911.
Erickson DR, Tomaszewski JE, Kunselman AR, et al.: Do the National Institute of Diabetes and Digestive and Kidney Diseases Cystoscopic criteria associate with other clinical and objective features of interstitial cystitis? J Urol 2005, 173:93–97.
Ottem DP, Teichman JMH: What is the value of cystoscopy with hydrodistension for interstitial cystitis? Urology 2005, 66:494–499.
Erickson DR, Tomaszewski JE, Kunselman AR, et al.: Urine markers do not predict bladder biopsy findings or presence of bladders ulcers in interstitial cystitis/painful bladder syndrome. J Urol 2008, 179:1850–1856.
Nickel JC: Interstitial cystitis: the paradigm shifts: international consultations on interstitial cystitis. Rev Urol 2004, 6:200–202.
Teichman JMH, Parsons CL: Contemporary clinical presentation of interstitial cystitis. Urology 2007, 69:41–47.
Ito T, Ueda T, Honma Y, Takei M: Recent trends in patient characteristics and therapeutic choices for interstitial cystitis: analysis of 282 Japanese patients. Int J Urol 2007, 14:1068–1070.
Parsons CL, Zupkas P, Parsons JK: Intravesical potassium sensitivity in patients with interstitial cystitis and urethral syndrome. Urology 2001, 57:428–433.
Minaglia S, Ozel B, Bizhang R, Mishell DR Jr: Increased prevalence of interstitial cystitis in women with detrusor overactivity refractory to anticholinergic therapy. Urology 2005, 66:702–706.
Evans RJ, Sant GR: Current diagnosis of interstitial cystitis: an evolving paradigm. Urology 2007, 69:64–72.
Berger RE, Miller JE, Rothman I, et al.: Bladder petechiae after cystoscopy and hydrodistension in men diagnosed with prostate pain. J Urol 1998, 159:83–85.
Parsons CL, Albo M: Intravesical potassium sensitivity in patients with prostatitis. J Urol 2002, 168:1054–1057.
Peters KM, Carrico DJ, Diokno AC: Characterization of a clinical cohort of 87 women with interstitial cystitis/painful bladder syndrome. Urology 2008, 71:634–640.
Diggs C, Meyer WA, Langenberg P, et al.: Assessing urgency in interstitial cystitis/painful bladder syndrome. Urology 2007, 69:210–214.
Greenberg P, Brown J, Yates T, et al.: Voiding urges perceived by patients with interstitial cystitis/painful bladder syndrome. Neurourol Urodyn 2008, 27:287–290.
Nickel JC, Teichman JMH, Gregoire M, et al.: Prevalence, diagnosis, characterization, and treatment of prostatitis, interstitial cystitis, and epididymitis in outpatient urological practice: the Canadian PIE study. Urology 2005, 66:935–940.
Parsons CL, Dell J, Stanford EJ, et al.: The prevalence of interstitial cystitis in gynecologic patients with pelvic pain, as detected by intravesical potassium sensitivity. Am J Obstet Gynecol 2002, 187:1395–1400.
Powell-Boone T, Ness TJ, Cannon R, et al.: Menstrual cycle affects bladder pain sensation in subjects with interstitial cystitis. J Urol 2005, 174:1832–1836.
Peters KM, Killinger KA, Carrico DJ, et al.: Sexual function and sexual distress in women with interstitial cystitis: a case-control study. Urology 2007, 70:543–547.
Zaslau S, Riggs D, Jackson B, Kandzari S: Update of the characterization of female sexual dysfunction in patients with interstitial cystitis 1000 respondents [abstract 301]. J Urol 2005, 173:83.
Ottem DP, Carr LK, Perks AE, et al.: Interstitial cystitis and female sexual dysfunction. Urology 2007, 69:608–610.
Duldulao KE, Diokno AC, Mitchell B: Value of urinary cytology in women presenting with urge incontinence and/or irritative voiding symptoms. J Urol 1997, 157:113–136.
Tissot WD, Diokno AC, Peters KM: A referral center’s experience with transitional cell carcinoma misdiagnosed as interstitial cystitis. J Urol 2004, 172:478–480.
Keay SK, Zhang CO, Shoenfelt J, et al.: Sensitivity and specificity of antiproliferative factor, heparin-binding epidermal growth factor-like growth factor, and epidermal growth factor as urine markers for interstitial cystitis. Urology 2001, 57:9–14.
Zhang CO, Li ZL, Shoenfelt JL, et al.: Comparison of APF activity and epithelial growth factor levels in urine from Chinese, African-American, and white American patients with interstitial cystitis. Urology 2003, 61:897–901.
Chai TC, Zhong C, Warren JW, Keay S: Percutaneous sacral third nerve root neurostimulation improves symptoms and normalizes urinary HB-EGF levels and antiproliferative activity in patients with interstitial cystitis. Urology 2000, 55:643–646.
Erickson DR, Kunselman AR, Bentley CM, et al.: Changes in urine markers and symptoms after bladder distention for interstitial cystitis. J Urol 2007, 177:556–560.
Keay S, Zhang CO, Chai T, et al.: Antiproliferative factor, heparin-binding epidermal growth factor-like growth factor, and epidermal growth factor in men with interstitial cystitis versus chronic pelvic pain syndrome. Urology 2004, 63:22–26.
Bates JM, Raffi HM, Prasadan K, et al.: Tamm-Horsfall protein knockout mice are more prone to urinary tract infection: rapid communication. Kidney Int 2004, 65:791–797.
Akiyama A, Stein PC, Houshiar A, Parsons CL: Urothelial cytoprotective activity of Tamm-Horsfall protein isolated from the urine of healthy subjects and patients with interstitial cystitis. Int J Urol 2000, 7:176–183.
Parsons CL, Rajasekaran M, Arsanjani AH, et al.: Role of sialic acid in urinary cytoprotective activity of Tamm-Horsfall protein. Urology 2007, 69:577–581.
Daha LK, Riedl CR, Hohlburgger G, et al.: Comparative assessment of maximal bladder capacity, 0.9% NaCl versus 0.2 M Kcl, for the diagnosis of interstitial cystitis: a prospective controlled study. J Urol 2003, 170:807–809.
Philip J, Willnott S, Owen D, et al.: A double-blind, randomized controlled trial of cystometry using saline versus 0.3 M potassium chloride infusion in women with overactive bladder syndrome. Neurourol Urodyn 2007, 26:110–114.
Teichman JMH, Nielson-Omeis BJ, McIver BD: Modi-fied urodynamics for interstitial cystitis. Tech Urol 1997, 3:65–68.
Shorter B, Lesser M, Moldwin RM, Kushner L: Effect of comestibles on symptoms of interstitial cystitis. J Urol 2007, 178:145–152.
Bologna RA, Gomelsky A, Lukban JC, et al.: The efficacy of calcium glycerophosphate in the prevention of food-related flares in interstitial cystitis. Urology 2001, 57:119–120.
Lutgendorf SK, Latini JM, Rothrock NE, et al.: Autonomic response to stress in interstitial cystitis. J Urol 2004, 172:227–231.
Spanos C, Pang X, Ligris K, et al.: Stress-induced bladder mast cell activation: implications for interstitial cystitis. J Urol 1997, 157:669–672.
Ripoll E, Mahowald D: Hatha Yoga therapy management of urologic disorders. World J Urol 2002, 20:306–309.
Webster DC, Brennan T: Use and effectiveness of psychological self-care strategies for interstitial cystitis. Health Care Women Int 1995, 16:463–475.
Whitmore KE: Complementary and alternative therapies as treatment approaches for interstitial cystitis. Rev Urol 2002, 4:S28–S35.
Geirsson G, Wang YH, Lindstrom S, Fall M: Traditional acupuncture and electrical stimulation of the posterior tibial nerve. A trial in chronic interstitial cystitis. Scand J Urol Nephrol 1993, 27:67–70.
O’Reilly BA, Dwyer PL, Hawthorne G, et al.: Transdermal posterior tibial nerve laser therapy is not effective in women with interstitial cystitis. J Urol 2004, 172:1880–1883.
Parsons CL, Benson G, Childs SJ, et al.: A quantitatively controlled method to study prospectively interstitial cystitis and demonstrate the efficacy of pentosan polysulate. J Urol 1993, 150:845–848.
Sant GR, Propert KJ, Hanno PM, et al.: A pilot clinical trial of oral pentosan polysulfate and oral hydroxyzine in patients with interstitial cystitis. J Urol 2003, 170:810–815.
Nickel JC, Barkin J, Forrest J, et al.: Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Urol 2005, 65:654–658.
Davis EL, El Khoudary SR, Talbott EO, et al.: Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol 2008, 179:177–185.
Van Ophoven A, Pokupic S, Heinecke H, Hertle L: A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol 2004, 172:533–536.
Van Ophoven A, Hertle L: The dual serotonin and noradrenaline reuptake inhibitor duloxetine for the treatment of interstitial cystitis: results of an observational study. J Urol 2007, 177:552–555.
Sairanen J, Tammela TL, Leppilahti M, et al.: Cyclosporine A and pentosan polysulfate sodium for the treatment of interstitial cystitis: a randomized comparative study. J Urol 2005, 174:2235–2238.
Sairanen J, Forsell T, Ruutu M: Long-term outcome of patients with interstitial cystitis treated with low dose cyclosporine A. J Urol 2004, 171:2138–2141.
ClinicalTrials.gov. A randomized multicenter double-blind CT to evaluate the efficacy and safety of mycophenolate mofetil. Available at http://clinicaltrials.gov/ct2/show/NCT00451867?term=mycophenolate+and+interstitial+cysti tis&rank=1. Accessed June 2008.
Zabihi N, Mourtzinos A, Maher MG, et al.: Short-term results of bilateral S2–S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful bladder syndrome, and chronic pelvic pain. Int J Urogynecol J Pelvic Floor Dysfunct 2008, 19:553–557.
Peters KM, Konstandt D: Sacral neuromodulation decreases narcotic requirements in refractory interstitial cystitis. BJU Int 2004, 93:777–779.
Comiter CV: Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis: a prospective study. J Urol 2003, 169:1369–1373.
Aboseif S, Tamaddon K, Chalfin S, et al.: Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction. Urology 2002, 60:52–56.
Maxwell KM, Clemens JQ, Mazzenga L, Kielb SJ: Reprogramming requirements after sacral nerve stimulator implantation: correlation with preoperative indication. J Urol 2008, 179:549–551.
Burks FN, Diokno AC, Lajiness MJ, et al.: Sacral neuromodulation reprogramming: is it an office burden? Int Urogynecol J Pelvic Floor Dysfunct 2008 (in press).
Moldwin RM, Evans RJ, Stanford EJ, Rosenberg MT: Rational approaches to the treatment of patients with interstitial cystitis. Urology 2007, 69:73–81.
Peters K, Diokno A, Steinert B, et al.: The efficacy of intravesical Tice strain bacillus Calmette-Guerin in the treatment of interstitial cystitis: a double-blind, prospective, placebo controlled trial. J Urol 1997, 157:2090–2094.
Mayer R, Propert KJ, Peters KM, et al.: A randomized controlled trial of intravesical bacillus Calmette-Guerin for treatment refractory interstitial cystitis. J Urol 2005, 173:1186–1191.
Propert KJ, Mayer R, Nickel JC, et al.: Followup of patients with interstitial cystitis responsive to treatment with intravesical bacillus Calmette-Guerin or placebo. J Urol 2008, 179:552–555.
Propert KJ, Mayer R, Nickel JC, et al.: Did patients with interstitial cystitis who failed to respond to initial treatment with bacillus Calmette-Guerin or placebo in a randomized clinical trial benefit from a second course of open label bacillus Calmette-Guerin? J Urol 2007, 178:886–870.
Henry R, Patterson L, Avery N, et al.: Absorption of alkalinized intravesical lidocaine in normal and inflamed bladders: a simple method for improving bladder anesthesia. J Urol 2001, 165:1900–1903.
Parsons CL: Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urology 2005, 65:45–48.
Welk BK, Teichman JMH: Dyspareunia response in patients with interstitial cystitis treated with intravesical lidocaine, bicarbonate, and heparin. Urology 2008, 71:67–70.
Giannantoni A, Porena M, Costantini E, et al.: Botulinum A toxin intravesical injection in patients with painful bladder syndrome: 1-year followup. J Urol 2008, 179:1031–1034.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Seth, A., Teichman, J.M.H. What’s new in the diagnosis and management of painful bladder syndrome/interstitial cystitis?. Curr Urol Rep 9, 349–357 (2008). https://doi.org/10.1007/s11934-008-0061-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11934-008-0061-9