CUA GL 2016 Diagnosis and Treatment of IC + BPS Flashcards
What is bladder pain syndrome as per SUFU/ CUA GL definition?
an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than six weeks duration, in the absence of infection or other identifiable causes.
What is mandatory in the initial work up of IC/BPS?
Hx and physical exam(abdominal and pelvic exam)
What is the most common presenting symptom of IC?
FREQUNECY
Name 3 medications that can cause cystitis?
Ketamine, cyclophosphamide, NSAIDs
What is the differential Diagnosis for IC/BPS?
Endometriosis, Non-infectious cystitis, Infectious cystitis, vulvar disorders, OAB, pudendal nerve entrapment, prostate related pain, pelvic pain disorders
What are recommended investigations in initial work up of IC/BPS?
Frequency volume charts, UA and culture, symptoms score, cystoscopy
What are optional investigations?
US, cytology, Intravesical anesthetic bladder challenge, hydrodistention
What is not recommended in initial work up of IC?
Potassium sensitivity test, bladder biopsy, UDS
what is the average voided volume in IC patients
86-174 ml vs 289ml in asymptomatic women
What percentage of IC patients have Hunner’s ulcers?
16%
How is intravesical bladder anesthetic challenge done?
20ml of 2% lidocaine, instill in bladder, keep for 15 min, drain via catheter. diagnostic of bladder source if improvement of symptoms occur
How is hydrodistension done?
under GA(or spinal), gravity fill the bladder(100cmH2O) for 2 minutes. you know it cant take no more when it backs up in flow chamber or leaks from urethra. if there is terminal hematuria or mucosal hemorrhages that is classic of IC.
What are some urodynamic findings observed in IC patients?
reduced first sensation to void(@ 81). Maximum sensory capacity ( @ 200) , 15% have DO
What interventions should all patients with IC have as part of their treatment?
Patient education, dietary modifications, sexual counselling, bladder training
What is recommended for patients with IC and pelvic floor dysfunction? or Tenderness on the exam?
Physiotherapy and massage, acupuncture, trigger point injections
what are medical treatment options for patients with IC with non hunner’s primary bladder symptoms?
Amitriptyline, cimetidine, hydroxyzine(in patients with allergy history), Pentosan polysulfate(PPS, conflicting evidence), Quercetin
What are treatment options for patients with Hunner’s ulcer?
endoscopic fulgration, laser, resection, steroid injection), HBOT, Radical surgery, Cyclosporine A
What are treatment options with patients with neurologic/systemic phenotype of IC?
gabapentinoids, hydroxyzine, cimetidine, sarcral neuromodulation
what are two agents approved by health canada for use in treatment of IC?
oral PPS and intravesical DMSO(dimethylsulfoxide)
what are side effects of DMSO?
hilatosis( garlic breath), worsening of symptoms after first instillations but improves after second one
what are intravesical therapies for management of IC?
DMSO, heparin, sodium bicarbonate(improves absorption of lidocaine by alkalinizing the bladder), chondroitin sulfate(should not be used as monotherapy) , lidocaine, Hyaluronic acid, PPS, oxybutinyn
What intravesical treatment options are not recommended for management of IC?
BCG, Resiniferatoxin(potent analogue of chili pepper extract capsacin)
what are MIS treatments for IC?
Hydrodistention, Botox(100 unit), Sacral neuromodulation
what are new and emerging therapies for IC wit supportive evidence?
HBOT, PDE-5 inhibitors,
What are the 6 domains of UPOINT system?
Urinary, psychological, organ specific, Infection, Neurologic, tenderness of skeletal muscles
