CUA GL 2016 Diagnosis and Treatment of IC + BPS

Question 1

What is bladder pain syndrome as per SUFU/ CUA GL definition?

Answer 1

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.

Question 2

What is mandatory in the initial work up of IC/BPS?

Answer 2

Hx and physical exam(abdominal and pelvic exam)

Question 3

What is the most common presenting symptom of IC?

Answer 3

FREQUNECY

Question 4

Name 3 medications that can cause cystitis?

Answer 4

Ketamine, cyclophosphamide, NSAIDs

Question 5

What is the differential Diagnosis for IC/BPS?

Answer 5

Endometriosis, Non-infectious cystitis, Infectious cystitis, vulvar disorders, OAB, pudendal nerve entrapment, prostate related pain, pelvic pain disorders

Question 6

What are recommended investigations in initial work up of IC/BPS?

Answer 6

Frequency volume charts, UA and culture, symptoms score, cystoscopy

Question 7

What are optional investigations?

Answer 7

US, cytology, Intravesical anesthetic bladder challenge, hydrodistention

Question 8

What is not recommended in initial work up of IC?

Answer 8

Potassium sensitivity test, bladder biopsy, UDS

Question 9

what is the average voided volume in IC patients

Answer 9

86-174 ml vs 289ml in asymptomatic women

Question 10

What percentage of IC patients have Hunner’s ulcers?

Answer 10

16%

Question 11

How is intravesical bladder anesthetic challenge done?

Answer 11

20ml of 2% lidocaine, instill in bladder, keep for 15 min, drain via catheter. diagnostic of bladder source if improvement of symptoms occur

Question 12

How is hydrodistension done?

Answer 12

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.

Question 13

What are some urodynamic findings observed in IC patients?

Answer 13

reduced first sensation to void(@ 81). Maximum sensory capacity ( @ 200) , 15% have DO

Question 14

What interventions should all patients with IC have as part of their treatment?

Answer 14

Patient education, dietary modifications, sexual counselling, bladder training

Question 15

What is recommended for patients with IC and pelvic floor dysfunction? or Tenderness on the exam?

Answer 15

Physiotherapy and massage, acupuncture, trigger point injections

Question 16

what are medical treatment options for patients with IC with non hunner’s primary bladder symptoms?

Answer 16

Amitriptyline, cimetidine, hydroxyzine(in patients with allergy history), Pentosan polysulfate(PPS, conflicting evidence), Quercetin

Question 17

What are treatment options for patients with Hunner’s ulcer?

Answer 17

endoscopic fulgration, laser, resection, steroid injection), HBOT, Radical surgery, Cyclosporine A

Question 18

What are treatment options with patients with neurologic/systemic phenotype of IC?

Answer 18

gabapentinoids, hydroxyzine, cimetidine, sarcral neuromodulation

Question 19

what are two agents approved by health canada for use in treatment of IC?

Answer 19

oral PPS and intravesical DMSO(dimethylsulfoxide)

Question 20

what are side effects of DMSO?

Answer 20

hilatosis( garlic breath), worsening of symptoms after first instillations but improves after second one

Question 21

what are intravesical therapies for management of IC?

Answer 21

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

Question 22

What intravesical treatment options are not recommended for management of IC?

Answer 22

BCG, Resiniferatoxin(potent analogue of chili pepper extract capsacin)

Question 23

what are MIS treatments for IC?

Answer 23

Hydrodistention, Botox(100 unit), Sacral neuromodulation

Question 24

what are new and emerging therapies for IC wit supportive evidence?

Answer 24

HBOT, PDE-5 inhibitors,

Question 25

What are the 6 domains of UPOINT system?

Answer 25

Urinary, psychological, organ specific, Infection, Neurologic, tenderness of skeletal muscles