Document 6429220

ESSIC 2008 Annual Meeting ‐ Rome
Interstitial Cystitis:
Diagnosis and Definition
ESSIC approach
pp
A painful,
painful potentially disabling,
disabling
inflammatory disease of the urinary
bladder of unknown etiology.
Jørgen Nordling, chairman ESSIC
Professor of Urology
University of Copenhagen
Denmark
NIDDK Criteria

NIDDK Criteria
Exclusions




Both


Bladder pain or urinary urgency; glomerulations or
Hunner’s ulcer









Cystometric awake capacity > 350 ml.
Using fill rate 3030-100ml/min, absence of intense urge to void at
100 ml gas or 150 ml liquid.
IVC on cystometry
Awake frequency < 8/day
No nocturia
i
Duration < 9 mdr.
Age < 18 years
Cystitis (bakterial, chemical, TB, XRT)
Prostatitis, Vaginitis
Bladder, uterine, cervix, vaginal, urethral cancer
Activ herpes
Bladder or lower ureteral calculi
Urethral diverticulum
Wein A et al.in Hanno et al.:
Interstitial Cystitis.SpringerCystitis.Springer-Verlag,
1990 33-15
ICS definition
Results:

The subcommittee found that in
the 15 years since publication of
the original NIDDK guidelines
there
h has
h bbeen no high
hi h quality
li
evidence to support the routine
use of any diagnostic test in
defining IC.

Painful Bladder syndrome (PBS) defined
by ICS “suprapubic pain related to
bladder filling, accompanied by other
symptoms such as increased daytime and
nighttime frequency in the absence of
infection or other pathology”.
IC: above with “typical cystoscopic and
histological features”
Abrams et al. Neurourol Urodyn
2002;21:167--78
2002;21:167
Diagnosis and Definition: ESSIC Approach ‐ J. Nordling
1
ESSIC 2008 Annual Meeting ‐ Rome
COPENHAGEN
WORKSHOP ON IC
May 22-24 2003
June 2004
Copenhagen

ESSIC 2005
Baden Austria
The European Society for the study of
Interstitiel Cystitis / Painful Bladder syndrome
(ESSIC) was founded.
www.essic.eu
ICS definition


Painful Bladder syndrome (PBS) defined
by ICS “suprapubic pain related to
bladder filling, accompanied by other
symptoms such as increased daytime and
nighttime frequency in the absence of
infection or other pathology”.
IC: above with “typical cystoscopic and
histological features”
Abrams et al. Neurourol Urodyn
2002;21:167--78
2002;21:167
Diagnosis and Definition: ESSIC Approach ‐ J. Nordling
PBS/IC and confusable diseases
carcinoma
carcinoma in situ
infection with intestinal bacteria
infection with
Mycobacterium tuberculosis
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Mycoplasma genitalis
Corynebacterium urealyticum
Candida species
Herpes simplex
Human Papilloma Virus
radiation cystitis
chemotherapy-induced cystitis
cyclophosphamide-induced cystitis
tiaprofenic acid-induced cystitis
bladder neck obstruction
neurogenic outlet obstruction
bladder stone
lower ureteric stone  upper UT imaging
urethral diverticulum
endometriosis
vaginal candidiasis
cervical uterine and ovarian cancer
cervical,
incomplete bladder emptying
(retention)
prostate cancer  PSA
benign prostatic obstruction
chronic bacterial prostatitis
 culture
chronic non-bacterial prostatitis
pudendal nerve entrapment nerve block
pelvic floor muscle related pain
PBS/IC
ESSIC consensus 2005-2006
2
ESSIC 2008 Annual Meeting ‐ Rome
medical history eliminates
carcinoma
carcinoma in situ
infection with intestinal bacteria
infection with
Mycobacterium tuberculosis
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Mycoplasma genitalis
Corynebacterium urealyticum
Candida species
Herpes simplex
Human Papilloma Virus
radiation cystitis
chemotherapy-induced cystitis
cyclophosphamide-induced cystitis
tiaprofenic acid-induced cystitis
bladder neck obstruction
neurogenic outlet obstruction
bladder stone
lower ureteric stone  upper UT imaging
urethral diverticulum
endometriosis
vaginal candidiasis
cervical uterine and ovarian cancer
cervical,
incomplete bladder emptying
(retention)
prostate cancer  PSA
benign prostatic obstruction
chronic bacterial prostatitis
 culture
chronic non-bacterial prostatitis
pudendal nerve entrapment nerve block
pelvic floor muscle related pain
PBS/IC
physical examination eliminates
carcinoma
carcinoma in situ
infection with intestinal bacteria
infection with
Mycobacterium tuberculosis
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Mycoplasma genitalis
Corynebacterium urealyticum
Candida species
Herpes simplex
Human Papilloma Virus
radiation cystitis
chemotherapy-induced cystitis
cyclophosphamide-induced cystitis
tiaprofenic acid-induced cystitis
bladder neck obstruction
neurogenic outlet obstruction
bladder stone
lower ureteric stone  upper UT imaging
urethral diverticulum
endometriosis
vaginal candidiasis
cervical uterine and ovarian cancer
cervical,
incomplete bladder emptying
(retention)
prostate cancer  PSA
benign prostatic obstruction
chronic bacterial prostatitis
 culture
chronic non-bacterial prostatitis
pudendal nerve entrapment nerve block
pelvic floor muscle related pain
PBS/IC
ESSIC consensus 2005-2006
ESSIC consensus 2005-2006
dipstick analysis and cultures
eliminate
carcinoma
bladder neck obstruction
flowmetry, pressurepressure-flow and
ultrasound
eliminate
carcinoma
bladder neck obstruction
carcinoma in situ
infection with intestinal bacteria
infection with
Mycobacterium tuberculosis
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Mycoplasma genitalis
Corynebacterium urealyticum
Candida species
Herpes simplex
Human Papilloma Virus
radiation cystitis
chemotherapy-induced cystitis
cyclophosphamide-induced cystitis
tiaprofenic acid-induced cystitis
carcinoma in situ
infection with intestinal bacteria
infection with
Mycobacterium tuberculosis
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Mycoplasma genitalis
Corynebacterium urealyticum
Candida species
Herpes simplex
Human Papilloma Virus
radiation cystitis
chemotherapy-induced cystitis
cyclophosphamide-induced cystitis
tiaprofenic acid-induced cystitis
neurogenic outlet obstruction
bladder stone
lower ureteric stone  upper UT imaging
urethral diverticulum
endometriosis
vaginal candidiasis
cervical uterine and ovarian cancer
cervical,
incomplete bladder emptying
(retention)
prostate cancer  PSA
benign prostatic obstruction
chronic bacterial prostatitis
 culture
chronic non-bacterial prostatitis
pudendal nerve entrapment nerve block
pelvic floor muscle related pain
PBS/IC
neurogenic outlet obstruction
bladder stone
lower ureteric stone  upper UT imaging
urethral diverticulum
endometriosis
vaginal candidiasis
cervical uterine and ovarian cancer
cervical,
incomplete bladder emptying
(retention)
prostate cancer  PSA
benign prostatic obstruction
chronic bacterial prostatitis
 culture
chronic non-bacterial prostatitis
pudendal nerve entrapment nerve block
pelvic floor muscle related pain
PBS/IC
ESSIC consensus 2005-2006
cystoscopy and biopsy if indicated
eliminate
carcinoma
bladder neck obstruction
carcinoma in situ
infection with intestinal bacteria
infection with
Mycobacterium tuberculosis
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Mycoplasma genitalis
Corynebacterium urealyticum
Candida species
Herpes simplex
Human Papilloma Virus
radiation cystitis
chemotherapy-induced cystitis
cyclophosphamide-induced cystitis
tiaprofenic acid-induced cystitis
neurogenic outlet obstruction
bladder stone
lower ureteric stone  upper UT imaging
urethral diverticulum
endometriosis
vaginal candidiasis
cervical uterine and ovarian cancer
cervical,
incomplete bladder emptying
(retention)
prostate cancer  PSA
benign prostatic obstruction
chronic bacterial prostatitis
 culture
chronic non-bacterial prostatitis
pudendal nerve entrapment nerve block
pelvic floor muscle related pain
PBS/IC
ESSIC consensus 2005-2006
Diagnosis and Definition: ESSIC Approach ‐ J. Nordling
ESSIC consensus 2005-2006
Leaving
carcinoma
carcinoma in situ
infection with intestinal bacteria
infection with
Mycobacterium tuberculosis
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Mycoplasma genitalis
Corynebacterium urealyticum
Candida species
Herpes simplex
Human Papilloma Virus
radiation cystitis
chemotherapy-induced cystitis
cyclophosphamide-induced cystitis
tiaprofenic acid-induced cystitis
bladder neck obstruction
neurogenic outlet obstruction
bladder stone
lower ureteric stone  upper UT imaging
urethral diverticulum
endometriosis
vaginal candidiasis
cervical uterine and ovarian cancer
cervical,
incomplete bladder emptying
(retention)
prostate cancer  PSA
benign prostatic obstruction
chronic bacterial prostatitis
 culture
chronic non-bacterial prostatitis
pudendal nerve entrapment nerve block
pelvic floor muscle related pain
PBS/IC
ESSIC consensus 2005-2006
3
ESSIC 2008 Annual Meeting ‐ Rome
Cystoscopy and morphology

Because it is widely felt, that cystoscopy and
bladder morphology provides important
information, it was decided to make a
classification including findings like
glomerulations and Hunner’s lesion during
cystoscopy with hydrodistension and
inflammatory or other changes at
morphological investigation of bladder
biopsies.
ICS definition


Painful Bladder syndrome (PBS) defined
by ICS “suprapubic pain related to
bladder filling, accompanied by other
symptoms such as increased daytime
and nighttime frequency in the absence
of infection or other pathology”.
IC: above with “typical cystoscopic and
histological features”
Abrams et al. Neurourol Urodyn
2002;21:167--78
2002;21:167
CONSENSUS ON PBS/IC
NOMENCLATURE
ESSIC MEETING LONDON 2006
CONSENSUS ON PBS/IC
NOMENCLATURE
ESSIC MEETING LONDON 2006
that the diagnosis
g
will be made on the basis of
the symptom of pain related to the urinary
bladder, accompanied by at least one other
urinary symptom such as day-time and nighttime frequency, exclusion of confusable diseases
as the cause of the symptoms and cystoscopy
with hydrodistension and biopsy if indicated*
that the diagnosis
g
will be made on the basis of
the symptom of pain, pressure, discomfort
related to the urinary bladder, accompanied by
at least one other urinary symptom such as daytime and night-time frequency, exclusion of
confusable diseases as the cause of the
symptoms and cystoscopy with hydrodistension
and biopsy if indicated*
Diagnosis and Definition: ESSIC Approach ‐ J. Nordling
4
ESSIC 2008 Annual Meeting ‐ Rome
ICS definition


Painful Bladder syndrome (PBS) defined
by ICS “suprapubic pain related to
bladder filling, accompanied by other
symptoms such as increased daytime and
nighttime frequency in the absence of
infection or other pathology”.
IC: above with “typical cystoscopic and
histological features”
CONSENSUS ON PBS/IC NOMENCLATURE
ESSIC MEETING LONDON 2006
that the diagnosis will be made on the basis of the
symptom of pain related to the urinary bladder,
bladder
accompanied by at least one other urinary
symptom such as day-time and night-time
frequency, exclusion of confusable diseases as
the cause of the symptoms and cystoscopy with
hydrodistension and biopsy if indicated*
Abrams et al. Neurourol Urodyn
2002;21:167--78
2002;21:167
ICS definition


Painful Bladder syndrome (PBS) defined
by ICS “suprapubic pain related to
bladder filling, accompanied by other
symptoms such as increased daytime and
nighttime frequency in the absence of
infection or other pathology”.
IC: above with “typical cystoscopic
and histological features”
Abrams et al. Neurourol Urodyn
2002;21:167--78
2002;21:167
CONSENSUS ON PBS/IC NOMENCLATURE
ESSIC MEETING LONDON 2006
that the diagnosis will be made on the basis of the
symptom of pain related to the urinary bladder,
bladder
accompanied by at least one other urinary
symptom such as day-time and night-time
frequency, exclusion of confusable diseases as the
cause of the symptoms and cystoscopy with
hydrodistension and biopsy if indicated*
*If indicated to document the type of BPS.
Taxonomy

Painful Bladder Syndrome does not fit into the
taxonomy of other pelvic pain syndromes
like:



Urethral pain syndrome
Vulvar pain syndrome
Etc.
Diagnosis and Definition: ESSIC Approach ‐ J. Nordling
Taxonomy

Painful Bladder Syndrome does not fit into the
taxonomy of other pelvic pain syndromes
like:




Urethral pain syndrome
Vulvar pain syndrome
Etc.
Interstitial Cystitis (IC) is a word so loaded
with different interpretations, that it should be
avoided .
5
ESSIC 2008 Annual Meeting ‐ Rome
Taxonomy
ESSIC definition 2008


It was therefore decided to use the name
Bladder Pain Syndrome in the future


Bladder Pain Syndrome (BPS) is diagnosed on the
basis of chronic pelvic pain, pressure, or discomfort
perceived to be related to the urinary bladder
accompanied by at least one other urinary symptom
such as persistent urge to void or frequency.
frequency
Confusable diseases as the cause of the symptoms
must be excluded.
The presence of other organ symptoms as well as
cognitive, behavioral, emotional, and sexual
symptoms should be addressed
van de Merwe J. et al. European
Urology 2008, 53:6053:60-67.

Thank You!
Diagnosis and Definition: ESSIC Approach ‐ J. Nordling
6