2016 70 Bladder Pain Syndrome

Question 1

** What is the definition of bladder pain syndrome? **

Answer 1

1. Pain/pressure/discomfort in pelvis/bladder
2. Associated with urinary Sx: frequency, urgency, nocturia, bladder filling pain
3. Lasting at least 6 weeks
4. With no identifiable cause

Question 2

** How should bladder pain syndrome be initially assessed? **

Answer 2

1. Hx: urinary Sx, pain, QoL
2. Urine dip +/- MSU
3. Physical exam
4. Frequency/volume charts

Question 3

** What are the differential diagnoses for bladder pain syndrome? **

Answer 3

1. Malignancy
2. Infection
3. Overactive bladder
4. Bladder calculi
5. Bladder outlet obstruction
6. Prolapse
7. Endometriosis
8. Radiation-induced cystitis
9. Drug-induced cystitis

Question 4

** What are the first-line treatments for bladder pain syndrome? **

Answer 4

1. Analgesia
2. Stress relief
3. Dietary modifications
4. Exercise
5. Physical therapy
6. Support groups

If Tx fails, refer to secondary care

Question 5

** What are the 2nd line treatments for bladder pain syndrome? **

Answer 5

1. Amitriptyline
2. Cimetidine (unlicensed, antihistamine)

If Tx fails, refer to MDT, pain team +/- clinical psychologist

Question 6

** What are the 3rd line treatments for bladder pain syndrome? **

Answer 6

Intravesical:
1. DMSO (dimethyl sulphoxide)
2. Heparin
3. Botox
4. Lidocaine
5. Chondroitin sulphate
6. Hyaluronic acid

Question 7

** What are the 4th line treatments for bladder pain syndrome? **

Answer 7

1. Neuromodulation: posterior tibial nerve or sacral nerve stimulation
2. Oral cyclosporine A

Question 8

** What are the 5th line treatments for bladder pain syndrome? **

Answer 8

1. Cystoscopy & hydrodistension
2. If Hunner lesions noted or major surgery considered, refer to a tertiary centre

Question 9

** What treatments are not recommended for bladder pain syndrome? **

Answer 9

1. Long-term antibiotics
2. Intravesical resiniferatoxin
3. Intravesical BCG
4. Intravesical PPS (pentosan polysulphate)
5. High-pressure long-duration hydrodistension
6. Long-term oral glucocorticoids

Question 10

** What treatments for bladder pain syndrome can be used in pregnancy? **

Answer 10

1. Oral amitriptyline
2. Intravesical heparin

Question 11

What is the prevalence of bladder pain syndrome?

Answer 11

2.3-6.5%

Question 12

How much more common is BPS in women than men?

Answer 12

2-5x

Question 13

What scoring systems are validated in bladder pain syndrome?

Answer 13

1. University of Wisconsin Interstatial Cystitis scale
2. O’Leary-Sant IC symptom index & IC problem index
3. Pelvic pain & urgency/frequency scale

Question 14

What foods & drinks can worsen bladder pain syndrome?

Answer 14

1. Alcohol
2. Citrus fruits
3. Coffee
4. Carbonated drinks
5. Tea
6. Chocolate
7. Tomatoes

Question 15

What surgical interventions are considered in bladder pain syndrome?

Answer 15

1. Total cystectomy & urinary diversion
2. Orthoptic Neón ladder formation
3. Ileal conduit

Question 16

What features should a bladder diary include?

Answer 16

1. Hourly time
2. Liquid intake (ml)
3. Volume of urine passed (ml)
4. Urine leaks (small, moderate, large)
5. Urgency (strong, moderate, mild)