Materiały źródłowe

• #1 Interstitial Cystitis Differential Diagnoses

  https://emedicine.medscape.com/article/2055505-differential

  Diagnosing interstitial cystitis remains difficult even more than a century after it was described by Skene, in 1887. No pathognomonic findings exist with regard to patient history, physical examination findings, laboratory findings, or cystoscopy findings. The exclusion of other clinical entities remains the foremost goal of the workup and evaluation of patients thought to have this condition. […] A careful, complete, and empathetic history and physical examination are critical. Cystoscopy is an adjunctive, although important, study. The classic Hunner ulcer in the setting of a small-capacity bladder (ie, assessed under anesthesia) is rarely seen to confirm the diagnosis with certainty. Until interstitial cystitis is defined completely or a definitive marker becomes universally available, the diagnosis remains one of exclusion. […] Clinically, the practitioner is somewhat obligated to consider these potential alternative diagnoses prior to diagnosing interstitial cystitis. The implications of a diagnosis of interstitial cystitis are profound in that it is a chronic condition without universally effective therapy.

• #2 :: International Neurourology Journal

  https://www.einj.org/m/journal/view.php?number=570

  Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by bladder discomfort, urinary frequency, urgency, and pelvic pain. […] The etiology and pathogenesis of this condition is still unknown and remains diagnosed by exclusion. […] The diagnosis of this condition was originally based on these symptomsbladder pain, urinary urgency, and evidence of supportive bladder pathology on cystoscopy under anesthesia (inflammatory infiltrate, granulation tissue, detrusor mastocytosis, intrafascicular fibrosis, and Hunners ulcers), and exclusion of other possible diagnoses. […] The ESSIC suggests an optimal modality for diagnosing IC/BPS using the 3-step-process described below. The first step is the selection of patients. It was agreed that BPS would be diagnosed based on chronic (6 months) pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder. The second step is exclusion of similar diseases through medical history, physical examination, urinalysis, urine cultures, prostate-specific antigen in males 40 years, uroflowmetry, postvoid residual urine volume by ultrasound scanning, cystoscopy, and biopsy.

• #3 Diagnosis | Interstitial Cystitis Association

  https://www.ichelp.org/understanding-ic/diagnosis/

  There is no definitive test to identify IC/BPS, doctors must rule out other treatable conditions before considering a diagnosis of IC/BPS. […] Because IC/BPS symptoms are similar to those of other disorders of the bladder and there is no definitive test to identify IC/BPS, doctors must rule out other treatable conditions before considering a diagnosis of IC/BPS. […] The diagnosis of IC/BPS is based on the presence of pain related to the bladder, usually accompanied by frequency and urgency […] absence of other diseases that could cause the symptoms. […] Once other conditions are excluded, patients with characteristic signs and symptoms generally are treated for presumed IC/BPS. […] In certain circumstances, some clinicians may choose to evaluate further, with cystoscopy with hydrodistention under general anesthesia, or with urodynamic studies, or lidocaine instillation.

• #4 Etiology, Pathogenesis, and Diagnosis of Interstitial Cystitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1476007/

  Interstitial cystitis is being diagnosed with increasing frequency; however, current diagnostic criteria are non-uniform, and there is significant overlap between chronic pelvic pain syndromes in men and women, interstitial cystitis, recurrent cystitis, and the overactive bladder syndrome. […] The diagnosis of interstitial cystitis can be made clinically and by cystoscopy and hydrodistension. […] The NIH-NIDDK criteria, though excellent for research studies, are not suitable for routine clinical diagnosis. […] Clinicians are increasingly comfortable diagnosing IC on the basis of symptoms (frequency, urgency, nocturia, and pain) in the absence of known infectious and/or neoplastic diseases. […] The potassium sensitivity test has been advocated as a minimally invasive, office diagnostic test for IC.

• #5 About Interstitial Cystitis | IC | CDC

  https://www.cdc.gov/interstitial-cystitis/about/index.html

  If you think you have IC, see a health care provider. They will first rule out other bladder conditions before diagnosing you with IC. […] Interstitial cystitis causes pain in the bladder area, below the belly button. Anyone at any age can have IC. It can last for years or be lifelong.

• #6 Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-interstitial-cystitis-bladder-pain-syndrome-beyond-the-basics/print

  Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) […] The diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) is based on a person’s symptoms and examination. A careful medical history, physical examination, and, sometimes, laboratory testing are needed to confirm the diagnosis and also to be sure that another condition (eg, bladder infection or kidney stone) is not the cause of symptoms. There is no single test that can definitively diagnose IC/BPS. […] Physical examination — The physical examination usually includes a complete pelvic examination with a brief rectal examination. Often, patients with IC/BPS have tenderness in the lower abdomen, hips, and buttocks. […] If an examination is too uncomfortable, some health care providers recommend that the patient begin a course of treatment for IC/BPS without further testing. If improvement is not seen, it may be necessary to perform more testing to confirm the diagnosis.

• #7 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Guideline Statement 1: The basic assessment should include a careful history, physical examination, and laboratory examination to document symptoms and signs that characterize IC/BPS and exclude other disorders that could be the cause of the patient’s symptoms. Clinical Principle […] Guideline Statement 2: Baseline voiding symptoms and pain levels should be obtained in order to measure subsequent treatment effects. Clinical Principle […] Guideline Statement 3: Cystoscopy and/or urodynamics should be considered when the diagnosis is in doubt; these tests are not necessary for making the diagnosis in uncomplicated presentations. Expert Opinion […] Guideline Statement 4: Cystoscopy should be performed in patients for whom Hunner lesions are suspected. Expert Opinion […] Guideline Statement 5: Treatment decisions should typically be made after shared decision-making, with the patient informed of the risks, potential benefits, and alternatives. Except for patients with Hunner lesions, initial treatment should be nonsurgical. Expert Opinion

• #8 Interstitial cystitis: Algorithm to simplify diagnosis of chronic urinary symptoms

  https://www.npwomenshealthcare.com/interstitial-cystitis-simplify-diagnosis/

  Interstitial cystitis: Algorithm to simplify diagnosis of chronic urinary symptoms […] This pre/post-test study was undertaken to determine whether an algorithm constructed in an electronic health record template would aid in diagnosing interstitial cystitis. The algorithm is presented and the study methods, results, and implications are described here. […] Interstitial cystitis (IC), also known as bladder pain syndrome, is a chronic illness with no definitive cause or cure. This disorder has no universally accepted name and is frequently underdiagnosed or misdiagnosed. […] The American Urological Association (AUA) describes IC as a disorder manifested by a perceived sensation of pain and pressure related to the bladder and associated with lower urinary tract symptoms of greater than 6 weeks duration, in the absence of infection or other identifiable causes. The incidence of IC in the United States is 3%-6%. Like irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia, IC is a functional somatic syndrome with distressing symptoms that persist in the absence of structural pathology. IC is typically diagnosed in midlife, even though symptoms frequently arise in early childhood or adolescence. In fact, 25% of adults with IC, 90% of whom are female, report the existence of symptoms since they were children.

• #9 Interstitial Cystitis Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/interstitial_cystitis/article.htm

  How is interstitial cystitis diagnosed? […] Urologists are physicians who specialize in the diagnosis and treatment of diseases of the urinary tract, including interstitial cystitis. […] Because the symptoms of IC/PBS are similar to those of other disorders of the urinary system and because there is no definitive test to identify IC/PBS, doctors must exclude other conditions before making a diagnosis of IC/PBS. […] Medical tests that help identify other conditions include: Urinalysis, Urine culture, Cystoscopy, Biopsy of the bladder wall, Laboratory examination of prostatic secretions (in men). […] Physical examination of an individual with IC/PBS may reveal tenderness of the bladder either when pushing on the abdomen over the bladder (just above the pubic bone) or during the pelvic examination in women.

• #10 Interstitial cystitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362

  Diagnosis of interstitial cystitis might include: […] Your health care provider may ask you to describe your symptoms and to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass. […] During a pelvic exam, your provider examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. […] A sample of your urine is analyzed for signs of a urinary tract infection. […] Your provider inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. […] During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. […] Your provider collects a urine sample and examines the cells to help rule out cancer. […] Your provider places (instills) two solutions water and potassium chloride into your bladder, one at a time. […] If you feel noticeably more pain or urgency with the potassium solution than with the water, your provider may diagnose interstitial cystitis.

• #11 Interstitial Cystitis (IC): Symptoms, Causes, Treatment

  https://www.webmd.com/urinary-incontinence-oab/interstitial-cystitis

  Theres no test for interstitial cystitis. If you go to your doctor complaining about bladder pain along with frequency and the urgency to pee, the next step is to rule out other conditions. […] People of both sexes would first need to rule out urinary tract infections, bladder cancer, sexually transmitted diseases, and kidney stones. […] In women and people AFAB, endometriosis is another possibility. For men or those AMAB, IC can be mistaken for an inflamed prostate or chronic pelvic pain syndrome. […] These tests can rule out other conditions: […] Urinalysis and urine culture. Youll be asked to pee in a cup. Itll be sent to a lab to check for infection. […] Postvoid residual urine volume. Using an ultrasound, this test measures the amount of pee that remains in your bladder after you go to the bathroom.

• #12 Wrong Diagnosis | Interstitial Cystitis Association

  https://www.ichelp.org/understanding-ic/diagnosis/wrong-diagnosis/

  Diagnosing IC/BPS can be challenging. […] The IC/BPS diagnosis process requires healthcare providers to rule out other conditions prior to making the clinical judgment that you have IC/BPS. […] IC/BPS is often mistaken for a urinary tract infection (UTI) or bladder infection, which it is not. […] The diagnosis of IC/BPS and overactive bladder (OAB) are easy to confuse. […] IC/BPS and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are conditions in men that are similar. […] You might confuse hemorrhagic cystitis with IC/BPS because the symptoms are similar. […] Controversy swirls around the idea that pudendal nerve problems might be mistaken for IC/BPS or maybe cause it and that surgery to fix it may be the best option. […] Much of the research about the causes of IC/BPS is striving to sort out the overlap of IC/BPS with other chronic conditions such as allergies, irritable bowel syndrome, and sensitive skin are three common overlapping conditions in the IC/BPS population. […] Diagnosing Complicated IC/BPS Cases.

• #13 Urology of Virginia | Diagnosis Interstitial Cystitis | Healthcare

  https://www.urologyofva.net/urological-conditions/interstitial-cystitis-ic/interstitial-cystitis-ic-diagnosis/

  There is no one single test that can be used to diagnose IC/BPS. We call it a diagnosis by exclusion meaning other, more easily recognizable problems are ruled out first, most commonly: Overactive bladder, Chronic bacterial cystitis, Bladder or other pelvic cancers, Gynecologic disorders (e.g., vaginal atrophy, pelvic congestion syndrome, endometriosis, adhesions), Chronic prostatitis in men, Pudendal nerve entrapment, Symptoms from prior pelvic radiation, Urinary stones, Rare bladder diseases (e.g., eosinophilic cystitis, malakoplakia), and more.

• #14 Interstitial Cystitis/Bladder Pain Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/132252

  Interstitial cystitis/bladder pain syndrome (IC/BPS), formerly called interstitial cystitis, is a chronic (6 weeks duration) pelvic condition that affects or appears to affect the urinary bladder with symptoms of discomfort, pressure, or pain. […] In many cases, because IC/BPS remains a diagnosis of exclusion, the condition is often identified late or misdiagnosed, particularly in men, as chronic prostatitis/chronic pelvic pain syndrome or overactive bladder. […] The urinary frequency is generally refractory to standard overactive bladder therapy, which should suggest considering a diagnosis of IC/BPS. […] Symptoms must last at least 6 weeks with negative urine cultures and no acceptable explanation or alternative diagnosis. […] IC/BPS should be considered in all patients originally diagnosed with overactive bladder who do not improve on standard therapy.

• #15 Interstitial Cystitis Symptoms, Diagnosis, & Treatment

  https://wisconsinurology.com/our-services/women/interstitial-cystitis/

  The urologists at Urology Associates diagnose and provide treatment for interstitial cystitis. Our urologists will rule out other disorders to make a proper diagnosis of interstitial cystitis and ensure the best possible outcome […] Interstitial cystitis is difficult to diagnose because symptoms may resemble other conditions, such as urinary tract infections (UTIs) and endometriosis. There are no current tests that can definitively diagnose IC. Instead, our urologists will rule out other conditions and potential causes for symptoms. A diagnosis may be made if symptoms are consistent with IC and have been present for at least 6 weeks. Some of the work-up our urologists may do include: Medical History, Bladder diary: A written record of your urinary symptoms, tracking urination and how much fluid you are consuming, Physical exam: In addition to a general exam, a pelvic or genial exam may be performed, Cystoscopy, Urine test: To rule out infection or other abnormalities in the urine, Biopsy: A sample of the bladder may be taken.

• #16 Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-interstitial-cystitis-bladder-pain-syndrome-beyond-the-basics/print

  Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) […] The diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) is based on a person’s symptoms and examination. A careful medical history, physical examination, and, sometimes, laboratory testing are needed to confirm the diagnosis and also to be sure that another condition (eg, bladder infection or kidney stone) is not the cause of symptoms. There is no single test that can definitively diagnose IC/BPS. […] Physical examination — The physical examination usually includes a complete pelvic examination with a brief rectal examination. Often, patients with IC/BPS have tenderness in the lower abdomen, hips, and buttocks. […] If an examination is too uncomfortable, some health care providers recommend that the patient begin a course of treatment for IC/BPS without further testing. If improvement is not seen, it may be necessary to perform more testing to confirm the diagnosis.

• #17 Interstitial cystitis (bladder pain syndrome) – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/297

  Interstitial cystitis (bladder pain syndrome) is a chronic, often debilitating clinical syndrome of urinary frequency, urgency, and pelvic pain. Symptoms vary with bladder filling. […] Diagnosis is one of exclusion, and physicians must carefully consider all patients with chronic pelvic pain as potential candidates. […] IC/BPS is a diagnosis of exclusion, so other common disease processes must first be excluded before effective treatment can be initiated. […] Key diagnostic factors include food or stress triggers, urinary urgency, urinary frequency, urinary incontinence, nocturia, dysuria, pelvic-floor pain, dyspareunia, worsening of symptoms before menses, urethral pain, bladder neck pain, suprapubic pain, levator ani pain, and pain after placement of Foley catheter. […] Diagnostic tests include urinalysis with microscopy and culture, vaginal wet prep, voiding diary, and urine cytology. […] Tests to consider include cystoscopy with hydrodistention of bladder and bladder biopsy. […] Emerging tests include stress protein gene assay, urine antiproliferative factor, and urine nerve growth factor (NGF).

• #18 Interstitial Cystitis: Urgency and Frequency Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1001/p1199.html

  After the above evaluations are completed, confirmation of the diagnosis of interstitial cystitis depends on cystoscopic findings. Hydrodistention of the bladder is often performed during cystoscopy under general anesthesia. […] Biopsies are indicated in patients with suspected interstitial cystitis to exclude specific bladder pathology such as carcinoma, dysplasia or tuberculosis; to confirm bladder wall inflammation; and to identify subgroups of patients, such as those with excessive mast cells or eosinophils. […] Urodynamic studies are not specifically diagnostic of interstitial cystitis. Radiographic studies, such as intravenous pyelography or voiding cystourethrography, are seldom indicated in the evaluation of patients with suspected interstitial cystitis. […] The symptoms of interstitial cystitis typically worsen in the week before menstruation in contrast to the symptoms of endometriosis, which are worse during menses. […] Urinary frequency in patients with interstitial cystitis averages 16 times per day but can be as much as 40 times per day. Nonbacteriuric patients with pyuria should be tested or empirically treated for Chlamydia infection.

• #19 Interstitial cystitis: Algorithm to simplify diagnosis of chronic urinary symptoms

  https://www.npwomenshealthcare.com/interstitial-cystitis-simplify-diagnosis/

  For all patients with IC, pain is the hallmark symptom. The site of pain ranges from the umbilicus to the perineal, inguinal, or perirectal areas. Pain may also radiate down the legs. Pain during sexual intercourse, or dyspareunia, is reported by 60% of young patients with IC. Urinary frequency is often the first symptom of IC to arise, but patients may not recognize it as a problem until they have endured many years of it. Among patients with IC, 92% report urinary frequency: 86% say that they urinate more than 11 times during a 24-hour period and 71% say that they urinate 3 or more times at night. […] The differential diagnosis (DDx) for IC appears in Table 1. Overactive bladder (OAB) and IC are often confused with each other because both conditions typically manifest with urinary frequency. The key differential symptom is pelvic pain; if such pain is present, OAB can be ruled out. Patients with OAB tend to void frequently because they fear leaking, whereas those with IC tend to void frequently with small volume, regardless of whether it is day or night to relieve or avoid pain.

• #20 Interstitial Cystitis: Urgency and Frequency Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1001/p1199.html

  Interstitial cystitis is diagnosed by cystoscopy and hydrodistention of the bladder. Glomerulations or Hunner’s ulcers found at cystoscopy are diagnostic. […] Interstitial cystitis is often underdiagnosed or improperly diagnosed. A presumptive diagnosis may be made by looking for appropriate clinical criteria. […] The most typical symptom of interstitial cystitis is pelvic pain. The pain is relieved by voiding small amounts of urine from the bladder, but soon recurs as the bladder fills. […] Conditions that must be excluded to diagnose interstitial cystitis include bacteriuria, Chlamydia trachomatis infection, prostatitis, herpes simplex virus infection, neoplasia, neuropathic bladder dysfunction and gynecologic diseases such as vaginitis, urethral diverticulum, vulvar vestibulitis and endometriosis.

• #21 Interstitial cystitis: Algorithm to simplify diagnosis of chronic urinary symptoms

  https://www.npwomenshealthcare.com/interstitial-cystitis-simplify-diagnosis/

  For all patients with IC, pain is the hallmark symptom. The site of pain ranges from the umbilicus to the perineal, inguinal, or perirectal areas. Pain may also radiate down the legs. Pain during sexual intercourse, or dyspareunia, is reported by 60% of young patients with IC. Urinary frequency is often the first symptom of IC to arise, but patients may not recognize it as a problem until they have endured many years of it. Among patients with IC, 92% report urinary frequency: 86% say that they urinate more than 11 times during a 24-hour period and 71% say that they urinate 3 or more times at night. […] The differential diagnosis (DDx) for IC appears in Table 1. Overactive bladder (OAB) and IC are often confused with each other because both conditions typically manifest with urinary frequency. The key differential symptom is pelvic pain; if such pain is present, OAB can be ruled out. Patients with OAB tend to void frequently because they fear leaking, whereas those with IC tend to void frequently with small volume, regardless of whether it is day or night to relieve or avoid pain.

• #22 Interstitial Cystitis: Urgency and Frequency Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/1001/p1199.html

  After the above evaluations are completed, confirmation of the diagnosis of interstitial cystitis depends on cystoscopic findings. Hydrodistention of the bladder is often performed during cystoscopy under general anesthesia. […] Biopsies are indicated in patients with suspected interstitial cystitis to exclude specific bladder pathology such as carcinoma, dysplasia or tuberculosis; to confirm bladder wall inflammation; and to identify subgroups of patients, such as those with excessive mast cells or eosinophils. […] Urodynamic studies are not specifically diagnostic of interstitial cystitis. Radiographic studies, such as intravenous pyelography or voiding cystourethrography, are seldom indicated in the evaluation of patients with suspected interstitial cystitis. […] The symptoms of interstitial cystitis typically worsen in the week before menstruation in contrast to the symptoms of endometriosis, which are worse during menses. […] Urinary frequency in patients with interstitial cystitis averages 16 times per day but can be as much as 40 times per day. Nonbacteriuric patients with pyuria should be tested or empirically treated for Chlamydia infection.

• #23 Interstitial Cystitis Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/interstitial_cystitis/article.htm

  How is interstitial cystitis diagnosed? […] Urologists are physicians who specialize in the diagnosis and treatment of diseases of the urinary tract, including interstitial cystitis. […] Because the symptoms of IC/PBS are similar to those of other disorders of the urinary system and because there is no definitive test to identify IC/PBS, doctors must exclude other conditions before making a diagnosis of IC/PBS. […] Medical tests that help identify other conditions include: Urinalysis, Urine culture, Cystoscopy, Biopsy of the bladder wall, Laboratory examination of prostatic secretions (in men). […] Physical examination of an individual with IC/PBS may reveal tenderness of the bladder either when pushing on the abdomen over the bladder (just above the pubic bone) or during the pelvic examination in women.

• #24 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Cystoscopy with hydrodistension under anesthesia has been widely used for diagnosis of interstitial cystitis/painful bladder syndrome based on the 1987 NIDDK diagnostic criteria. […] Bladder biopsies are not performed routinely in the United States, although they are widely used to diagnose interstitial cystitis/painful bladder syndrome in Europe. […] The symptoms of interstitial cystitis/painful bladder syndrome often mimic urinary tract infection, but cultures are negative. […] There are two symptom screening questionnaires available for use in office practice: the O’Leary-Sant Symptom and Problem Index and the Pelvic Pain and Urgency/Frequency Symptom Scale (PUF). […] The examination should include a bimanual pelvic examination in women and digital rectal examination in men. Examination of patients with interstitial cystitis/painful bladder syndrome may reveal pelvic floor spasms, rectal spasms, or suprapubic tenderness.

• #25 Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-interstitial-cystitis-bladder-pain-syndrome-beyond-the-basics/print

  Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) […] The diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) is based on a person’s symptoms and examination. A careful medical history, physical examination, and, sometimes, laboratory testing are needed to confirm the diagnosis and also to be sure that another condition (eg, bladder infection or kidney stone) is not the cause of symptoms. There is no single test that can definitively diagnose IC/BPS. […] Physical examination — The physical examination usually includes a complete pelvic examination with a brief rectal examination. Often, patients with IC/BPS have tenderness in the lower abdomen, hips, and buttocks. […] If an examination is too uncomfortable, some health care providers recommend that the patient begin a course of treatment for IC/BPS without further testing. If improvement is not seen, it may be necessary to perform more testing to confirm the diagnosis.

• #26 Interstitial cystitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362

  Diagnosis of interstitial cystitis might include: […] Your health care provider may ask you to describe your symptoms and to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass. […] During a pelvic exam, your provider examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. […] A sample of your urine is analyzed for signs of a urinary tract infection. […] Your provider inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. […] During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. […] Your provider collects a urine sample and examines the cells to help rule out cancer. […] Your provider places (instills) two solutions water and potassium chloride into your bladder, one at a time. […] If you feel noticeably more pain or urgency with the potassium solution than with the water, your provider may diagnose interstitial cystitis.

• #27 Interstitial cystitis: Algorithm to simplify diagnosis of chronic urinary symptoms

  https://www.npwomenshealthcare.com/interstitial-cystitis-simplify-diagnosis/

  The Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale is a simple tool to further characterize a patients complaints and narrow the DDx. This scale includes urogynecologic symptoms and has three questions each on urinary frequency, urgency, and pelvic pain and two questions on symptoms associated with intercourse. A PUF scale score 13 justifies a possible IC diagnosis. […] A frequency volume chart (FVC) is a simple tool that assesses the average volume that a person is voiding. A person with IC voids an average of 100 mL 17-25 times a day, as compared with 289 mL 6 times a day in an asymptomatic person. […] A combination of negative urinalysis and urine culture findings, chronic urinary symptoms, chronic pelvic pain, and a positive AVWT finding on physical exam is sufficient evidence to diagnose IC. Adding an elevated PUF scale score and an FVC confirming frequent voiding in small amounts can give HCPs confidence that they have the correct diagnosis.

• #28 Interstitial Cystitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15735-interstitial-cystitis-painful-bladder-syndrome

  How is interstitial cystitis/bladder pain syndrome diagnosed? There arent any specific tests to diagnose interstitial cystitis/bladder pain syndrome. However, a healthcare provider will order tests to rule out other infections or conditions. These tests may include: […] A healthcare provider may ask you to record your symptoms in a journal or diary. They may also ask you to record what you drink, how much you drink and how much you pee. […] Youll provide a pee sample, and a healthcare provider will examine it under a microscope to look for blood in your pee (hematuria) and signs of an infection, such as organisms, germs, pus or white blood cells. A provider will prescribe antibiotics to treat an infection. A provider may diagnose IC/BPS if your pee is sterile after treatment, but you still have symptoms.

• #29 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  The diagnosis of interstitial cystitis is most often made when long-standing urinary frequency, urgency, and pelvic pain exist in the absence of a readily identifiable etiology, such as urinary tract infection (UTI). Urinalysis and urine culture are mandatory. A voiding diary is helpful in establishing baseline voiding frequency. […] Cystoscopy is considered by some clinicians to be mandatory in order to diagnose interstitial cystitis However, this is somewhat controversial because of the lack of specific or pathognomonic findings (except perhaps the very rare finding of a Hunner ulcer). […] Urodynamic evaluation is optional, and finding detrusor overactivity or pelvic floor dysfunction may suggest an alternative diagnosis. […] No known radiographic, ultrasonographic, or other imaging findings are specific for interstitial cystitis.

• #30 Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-interstitial-cystitis-bladder-pain-syndrome-beyond-the-basics/print

  Laboratory tests — Most clinicians perform a urine test to ensure that a person’s symptoms are not related to another condition, such as a kidney stone or bladder infection. […] Cystoscopy — Cystoscopy is a test that lets a doctor examine the inside of the bladder. Cystoscopy is not required to diagnose IC/BPS but may be recommended in certain situations.

• #31 Interstitial Cystitis – Diagnosis

  https://www.medindia.net/health/conditions/interstitial-cystitis-diagnosis.htm

  The symptoms of interstitial cystitis (IC) /painful bladder syndrome closely resemble those of other conditions of the bladder that are treatable. Therefore, the first step in IC/PBS diagnosis in both sexes is ruling out other disease conditions such as bladder cancer and urinary tract infection. In women endometriosis, which involves pelvic pain, must also be ruled out while in men, chronic prostatitis (chronic pelvic pain syndrome) is the disease to look for before focusing on IC/PBS. […] Frequency and urgency of urination, pain in pelvic area and absence of other treatable diseases are the pointers that could indicate IC/PBS. […] Examining urine under a microscope, and culturing urine samples, can help to rule out urinary tract infections. If the symptoms continue to persist, despite the urine sample being sterile, IC/PBS might be suspected.

• #32 Interstitial Cystitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15735-interstitial-cystitis-painful-bladder-syndrome

  How is interstitial cystitis/bladder pain syndrome diagnosed? There arent any specific tests to diagnose interstitial cystitis/bladder pain syndrome. However, a healthcare provider will order tests to rule out other infections or conditions. These tests may include: […] A healthcare provider may ask you to record your symptoms in a journal or diary. They may also ask you to record what you drink, how much you drink and how much you pee. […] Youll provide a pee sample, and a healthcare provider will examine it under a microscope to look for blood in your pee (hematuria) and signs of an infection, such as organisms, germs, pus or white blood cells. A provider will prescribe antibiotics to treat an infection. A provider may diagnose IC/BPS if your pee is sterile after treatment, but you still have symptoms.

• #33 Interstitial cystitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362

  Diagnosis of interstitial cystitis might include: […] Your health care provider may ask you to describe your symptoms and to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass. […] During a pelvic exam, your provider examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. […] A sample of your urine is analyzed for signs of a urinary tract infection. […] Your provider inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. […] During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. […] Your provider collects a urine sample and examines the cells to help rule out cancer. […] Your provider places (instills) two solutions water and potassium chloride into your bladder, one at a time. […] If you feel noticeably more pain or urgency with the potassium solution than with the water, your provider may diagnose interstitial cystitis.

• #34 Diagnosing interstitial cystitis: Tests and when to seek help

  https://www.medicalnewstoday.com/articles/how-is-interstitial-cystitis-diagnosed

  A urine cytology test screens a persons urine for abnormal or cancerous cells. […] Urologists may order these tests if a person experiences frequent burning or stinging sensations during urination, has blood in their urine, or experiences pain while urinating. […] A cystoscopy is a diagnostic procedure in which a urologist inserts a thin tube called a cystoscope into a persons urethra. […] This tool allows the urologist to view the bladder and urethra to look for inflammation or swelling, bladder ulcers, and signs of infection. […] According to the Interstitial Cystitis Association, cystoscopy with hydrodistension is no longer the standard method of diagnosing IC/BPS. […] However, this procedure can help identify Hunners lesions, which are painful ulcers or patches that appear on the bladder wall in 510% of people with IC/BPS.

• #35 Interstitial Cystitis – Diagnosis

  https://www.medindia.net/health/conditions/interstitial-cystitis-diagnosis.htm

  In this test a sample of urine of the patient is centrifuged and the sediments are seen under the microscope. It is a useful test to rule out malignancy of the bladder. […] During cytoscopy, a cytoscope, is used to see the bladder clearly and to study its abnormalities, if any. […] To rule out cancer a piece of the bladder tissue is removed (biopsy), during cytoscopy, to be studied under the microscope. […] Biopsy in Grade II to IV – if done normally may reveal a certain pattern of changes that indicates it to be a case of IC. These changes includes- Presence of Mast cell count in lamina propria, Complete loss of urothelial lining, Granulation tissue in lamina propria, Increase in vascular density in lamina propria on factor VIII (F8) stain.

• #36 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  Urethral and vaginal culture results should be obtained for pathologic organisms (eg, fungi and gonorrheal, chlamydial, and trichomonal species). […] Various assays for stress protein genes, glycosaminoglycans, mast cell tryptase, Tamm-Horsfall protein autoantibodies, and others have been suggested by numerous investigators. […] In men, expressed prostatic secretions yield no findings specific for interstitial cystitis. […] Ke et al propose that the serum neutrophil-to-lymphocyte ratio (NLR) holds promise as a biomarker for diagnosis and symptom evaluation in patients with interstitial cystitis/bladder pain syndrome. […] Cystoscopy is described as the most important diagnostic tool for assessing a patient who may have interstitial cystitis. […] Cystoscopy, with bladder overdistention, is performed to help exclude other causes of symptoms suggestive of interstitial cystitis and to provide evidence for the diagnosis of interstitial cystitis.

• #37 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  Urethral and vaginal culture results should be obtained for pathologic organisms (eg, fungi and gonorrheal, chlamydial, and trichomonal species). […] Various assays for stress protein genes, glycosaminoglycans, mast cell tryptase, Tamm-Horsfall protein autoantibodies, and others have been suggested by numerous investigators. […] In men, expressed prostatic secretions yield no findings specific for interstitial cystitis. […] Ke et al propose that the serum neutrophil-to-lymphocyte ratio (NLR) holds promise as a biomarker for diagnosis and symptom evaluation in patients with interstitial cystitis/bladder pain syndrome. […] Cystoscopy is described as the most important diagnostic tool for assessing a patient who may have interstitial cystitis. […] Cystoscopy, with bladder overdistention, is performed to help exclude other causes of symptoms suggestive of interstitial cystitis and to provide evidence for the diagnosis of interstitial cystitis.

• #38 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  Urethral and vaginal culture results should be obtained for pathologic organisms (eg, fungi and gonorrheal, chlamydial, and trichomonal species). […] Various assays for stress protein genes, glycosaminoglycans, mast cell tryptase, Tamm-Horsfall protein autoantibodies, and others have been suggested by numerous investigators. […] In men, expressed prostatic secretions yield no findings specific for interstitial cystitis. […] Ke et al propose that the serum neutrophil-to-lymphocyte ratio (NLR) holds promise as a biomarker for diagnosis and symptom evaluation in patients with interstitial cystitis/bladder pain syndrome. […] Cystoscopy is described as the most important diagnostic tool for assessing a patient who may have interstitial cystitis. […] Cystoscopy, with bladder overdistention, is performed to help exclude other causes of symptoms suggestive of interstitial cystitis and to provide evidence for the diagnosis of interstitial cystitis.

• #39

  https://journals.lww.com/ursc/fulltext/2021/32010/toward_a_validated_diagnostic_test_with_machine.2.aspx

  Diagnosing interstitial cystitis/bladder pain syndrome (IC/BPS) is difficult as there is no definitive test for IC/BPS. Instead, the diagnosis is based on urinary symptoms and cystoscopy may be recommended. […] However, cystoscopic diagnosis is associated with potentially exacerbating painful side effects and is highly subjective among physicians. Furthermore, IC/PBS symptoms overlap with symptoms of bladder cancer, urinary tract infection, or overactive bladder. As a result, many patients may go years without a correct diagnosis and proper disease management. The goal of our current IC/BPS research is to develop a simple diagnostic test based on several urine proteins called the IC-risk score (IC-RS). A machine learning (ML) algorithm uses this information to determine if a person has IC/BPS or not; if they have IC/BPS, whether their IC/BPS is characterized by Hunner’s lesions.

• #40 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Guideline Statement 1: The basic assessment should include a careful history, physical examination, and laboratory examination to document symptoms and signs that characterize IC/BPS and exclude other disorders that could be the cause of the patient’s symptoms. Clinical Principle […] Guideline Statement 2: Baseline voiding symptoms and pain levels should be obtained in order to measure subsequent treatment effects. Clinical Principle […] Guideline Statement 3: Cystoscopy and/or urodynamics should be considered when the diagnosis is in doubt; these tests are not necessary for making the diagnosis in uncomplicated presentations. Expert Opinion […] Guideline Statement 4: Cystoscopy should be performed in patients for whom Hunner lesions are suspected. Expert Opinion […] Guideline Statement 5: Treatment decisions should typically be made after shared decision-making, with the patient informed of the risks, potential benefits, and alternatives. Except for patients with Hunner lesions, initial treatment should be nonsurgical. Expert Opinion

• #41 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  Urethral and vaginal culture results should be obtained for pathologic organisms (eg, fungi and gonorrheal, chlamydial, and trichomonal species). […] Various assays for stress protein genes, glycosaminoglycans, mast cell tryptase, Tamm-Horsfall protein autoantibodies, and others have been suggested by numerous investigators. […] In men, expressed prostatic secretions yield no findings specific for interstitial cystitis. […] Ke et al propose that the serum neutrophil-to-lymphocyte ratio (NLR) holds promise as a biomarker for diagnosis and symptom evaluation in patients with interstitial cystitis/bladder pain syndrome. […] Cystoscopy is described as the most important diagnostic tool for assessing a patient who may have interstitial cystitis. […] Cystoscopy, with bladder overdistention, is performed to help exclude other causes of symptoms suggestive of interstitial cystitis and to provide evidence for the diagnosis of interstitial cystitis.

• #42 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Guideline Statement 1: The basic assessment should include a careful history, physical examination, and laboratory examination to document symptoms and signs that characterize IC/BPS and exclude other disorders that could be the cause of the patient’s symptoms. Clinical Principle […] Guideline Statement 2: Baseline voiding symptoms and pain levels should be obtained in order to measure subsequent treatment effects. Clinical Principle […] Guideline Statement 3: Cystoscopy and/or urodynamics should be considered when the diagnosis is in doubt; these tests are not necessary for making the diagnosis in uncomplicated presentations. Expert Opinion […] Guideline Statement 4: Cystoscopy should be performed in patients for whom Hunner lesions are suspected. Expert Opinion […] Guideline Statement 5: Treatment decisions should typically be made after shared decision-making, with the patient informed of the risks, potential benefits, and alternatives. Except for patients with Hunner lesions, initial treatment should be nonsurgical. Expert Opinion

• #43 Interstitial cystitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362

  Diagnosis of interstitial cystitis might include: […] Your health care provider may ask you to describe your symptoms and to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass. […] During a pelvic exam, your provider examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. […] A sample of your urine is analyzed for signs of a urinary tract infection. […] Your provider inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. […] During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. […] Your provider collects a urine sample and examines the cells to help rule out cancer. […] Your provider places (instills) two solutions water and potassium chloride into your bladder, one at a time. […] If you feel noticeably more pain or urgency with the potassium solution than with the water, your provider may diagnose interstitial cystitis.

• #44 Interstitial Cystitis/Bladder Pain Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/132252

  Neither cystoscopy nor urodynamics is required to diagnose IC/BPS according to the AUA guidelines. Neither is diagnostic, but they may be appropriate if the diagnosis is in doubt. […] Cystoscopy primarily rules out malignancy, strictures, Hunner ulcers, and bladder outlet obstruction. […] A Hunner ulcer is characteristic and diagnostic of classic IC. […] Patients with Hunner ulcers generally respond well to treatment. […] Patients who do not respond adequately to the above treatments may be candidates for the following: Botulinum toxin A detrusor injections, Cyclosporine A, Neuromodulation, Misoprostol (oral or intravesical), Tibial nerve stimulation. […] Definitive surgical therapy is reserved for patients who continue to have significant symptoms that have not been adequately controlled with any of the listed alternative treatments.

• #45 Interstitial Cystitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15735-interstitial-cystitis-painful-bladder-syndrome

  A provider will examine the inside of your urethra and bladder with a thin, lighted tube with an eyepiece on one end (cystoscope) to help rule out bladder cancer. […] A provider may perform cystoscopy with bladder hydrodistension. Theyll perform a cystoscopy and stretch (distend) your bladder as big as possible (to maximum capacity) by filling it with water. This procedure can reveal ulcers or cracks in your bladder. Its a painful procedure, so it requires anesthesia. But many people have temporary relief of their IC/BPS symptoms after.

• #46 Interstitial Cystitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15735-interstitial-cystitis-painful-bladder-syndrome

  A provider will examine the inside of your urethra and bladder with a thin, lighted tube with an eyepiece on one end (cystoscope) to help rule out bladder cancer. […] A provider may perform cystoscopy with bladder hydrodistension. Theyll perform a cystoscopy and stretch (distend) your bladder as big as possible (to maximum capacity) by filling it with water. This procedure can reveal ulcers or cracks in your bladder. Its a painful procedure, so it requires anesthesia. But many people have temporary relief of their IC/BPS symptoms after.

• #47 Diagnosing interstitial cystitis: Tests and when to seek help

  https://www.medicalnewstoday.com/articles/how-is-interstitial-cystitis-diagnosed

  A urine cytology test screens a persons urine for abnormal or cancerous cells. […] Urologists may order these tests if a person experiences frequent burning or stinging sensations during urination, has blood in their urine, or experiences pain while urinating. […] A cystoscopy is a diagnostic procedure in which a urologist inserts a thin tube called a cystoscope into a persons urethra. […] This tool allows the urologist to view the bladder and urethra to look for inflammation or swelling, bladder ulcers, and signs of infection. […] According to the Interstitial Cystitis Association, cystoscopy with hydrodistension is no longer the standard method of diagnosing IC/BPS. […] However, this procedure can help identify Hunners lesions, which are painful ulcers or patches that appear on the bladder wall in 510% of people with IC/BPS.

• #48 Interstitial Cystitis/Bladder Pain Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/132252

  Neither cystoscopy nor urodynamics is required to diagnose IC/BPS according to the AUA guidelines. Neither is diagnostic, but they may be appropriate if the diagnosis is in doubt. […] Cystoscopy primarily rules out malignancy, strictures, Hunner ulcers, and bladder outlet obstruction. […] A Hunner ulcer is characteristic and diagnostic of classic IC. […] Patients with Hunner ulcers generally respond well to treatment. […] Patients who do not respond adequately to the above treatments may be candidates for the following: Botulinum toxin A detrusor injections, Cyclosporine A, Neuromodulation, Misoprostol (oral or intravesical), Tibial nerve stimulation. […] Definitive surgical therapy is reserved for patients who continue to have significant symptoms that have not been adequately controlled with any of the listed alternative treatments.

• #49 Interstitial Cystitis/Painful Bladder Syndrome – The Urology Foundation

  https://www.theurologyfoundation.org/urology-health/bladder-conditions/5631-2/

  Interstitial cystitis (IC)/painful bladder syndrome is a chronic condition that is characterised by varying degrees of bladder pain and discomfort. […] IC/PBS is usually diagnosed by excluding other urinary conditions first as there is no conclusive test at present. […] A full medical history is taken to evaluate your symptom history and other medical conditions. […] Urine is usually sent away to check for infection although whilst IC/PBS is not thought to be caused by an active bacterial infection, there could still be one present. […] A cystoscopy (telescopic bladder examination) might be performed to examine the bladder lining for signs of inflammation or ulceration. […] Referral to a urologist is often necessary depending on presentation of your symptoms. […] Glomerulations are areas of pinpoint bleeding that can sometimes be observed during a cystoscopy in some people with IC/PBS. These bleeding points are considered to be a characteristic finding in the diagnosis of IC/PBS although they are not present in all cases.

• #50  Interstitial Cystitis Network  – How is Bladder Pain Syndrome & Interstitial Cystitis Diagnosed?

  https://www.ic-network.com/interstitial-cystitis-diagnosis/

  According to the 2022 American Urology Association Guidelines for IC/BPS, your physician should: […] Interstitial cystitis is the presumed diagnosis in patients who struggle with urinary symptoms (pain, frequency, urgency) for six weeks or longer and who have negative laboratory results for infection. […] The American Urology Association does NOT recommend additional invasive testing UNLESS the diagnosis is in doubt. […] If Hunner’s lesions are identified during the hydrodistention and cystoscopy, a diagnosis of IC is confirmed. Glomerulations are suggestive of, but not specific to, a diagnosis of IC because they can occur in other bladder conditions as well.

• #51 Interstitial Cystitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15735-interstitial-cystitis-painful-bladder-syndrome

  A provider will examine the inside of your urethra and bladder with a thin, lighted tube with an eyepiece on one end (cystoscope) to help rule out bladder cancer. […] A provider may perform cystoscopy with bladder hydrodistension. Theyll perform a cystoscopy and stretch (distend) your bladder as big as possible (to maximum capacity) by filling it with water. This procedure can reveal ulcers or cracks in your bladder. Its a painful procedure, so it requires anesthesia. But many people have temporary relief of their IC/BPS symptoms after.

• #52 Interstitial Cystitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15735-interstitial-cystitis-painful-bladder-syndrome

  A provider will examine the inside of your urethra and bladder with a thin, lighted tube with an eyepiece on one end (cystoscope) to help rule out bladder cancer. […] A provider may perform cystoscopy with bladder hydrodistension. Theyll perform a cystoscopy and stretch (distend) your bladder as big as possible (to maximum capacity) by filling it with water. This procedure can reveal ulcers or cracks in your bladder. Its a painful procedure, so it requires anesthesia. But many people have temporary relief of their IC/BPS symptoms after.

• #53 Bladder Pain Syndrome | Conditions & Treatments | UR Medicine

  https://www.urmc.rochester.edu/conditions-and-treatments/interstitial-cystitis

  Diagnosing interstitial cystitis can be difficult due to the wide variety of symptoms patients experience. Your provider will likely try to rule out any related conditions first, including: […] Common tools and tests used to diagnose interstitial cystitis include: […] Cystoscopy with hydrodistension, performed under general anesthesia, stretches the bladder with fluid. This test can be used to confirm an IC diagnosis and may lead to temporary relief of symptoms.

• #54 Interstitial cystitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362

  Diagnosis of interstitial cystitis might include: […] Your health care provider may ask you to describe your symptoms and to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass. […] During a pelvic exam, your provider examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. […] A sample of your urine is analyzed for signs of a urinary tract infection. […] Your provider inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. […] During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. […] Your provider collects a urine sample and examines the cells to help rule out cancer. […] Your provider places (instills) two solutions water and potassium chloride into your bladder, one at a time. […] If you feel noticeably more pain or urgency with the potassium solution than with the water, your provider may diagnose interstitial cystitis.

• #55 Diagnosing interstitial cystitis: Tests and when to seek help

  https://www.medicalnewstoday.com/articles/how-is-interstitial-cystitis-diagnosed

  A bladder wall biopsy is a diagnostic procedure in which a urologist removes a small sample of the bladder tissue for analysis under a microscope. […] A biopsy is not necessary to confirm a diagnosis of IC/BPS, but it can help rule out bladder cancer. […] Healthcare professionals may ask males who are experiencing symptoms of IC/BPS to undergo an examination of prostate secretions to rule out prostatitis an infection and inflammation of the prostate gland that can have similar symptoms to IC/BPS. […] Potassium chloride sensitivity testing (PST) is a controversial diagnostic method for IC/BPS. […] This test involves instilling a persons bladder with water and potassium chloride solution, a known irritant. […] People should consult a doctor about the risks and benefits of a PST. […] IC/BPS is a chronic bladder condition that can affect anyone of any sex. People who suspect that they have IC/BPS should contact a doctor for testing and treatment. […] Getting a diagnosis is the first step toward relief.

• #56 Etiology, Pathogenesis, and Diagnosis of Interstitial Cystitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1476007/

  However, at least one quarter (25%) of patients with IC (with either clinical or NIH-NIDDK research criteria) will remain undiagnosed if the KCl test is the sole diagnostic modality. […] The current consensus is that urodynamic evaluation is not required for diagnosis of IC but may provide useful information regarding the differential diagnosis of painful voiding disorders and the symptoms of the overactive bladder. […] Bladder biopsy is not required for the diagnosis of IC, as there are no pathognomonic histological features of the disease. […] The search for noninvasive techniques for diagnosis of IC has led to the study of urinary markers. […] The undue reliance on the NIH-NIDDK criteria for diagnosis has led to significant underdiagnosis of IC as shown by the ICDB Study. […] The previously rigid, monolithic approach to diagnosis employing the NIH-NIDDK criteria is no longer tenable, as clinicians increasingly rely on clinical diagnosis. […] Currently, there is no diagnostic tool for IC that has universal applicability.

• #57 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  No pathognomonic histologic findings exist for interstitial cystitis, although some authors have found increased numbers of mast cells in the detrusor muscle or submucosa in affected individuals. […] Some authors have found that certain subgroups of patients with interstitial cystitis have increased urothelial permeability to certain intravesical constituents. […] Urinalysis results are usually normal. […] Urodynamic studies are not part of the routine evaluation for interstitial cystitis. […] Pain with bladder filling that reproduces the patients’ interstitial cystitis symptoms is very supportive of a diagnosis of interstitial cystitis.

• #58 Interstitial Cystitis – Diagnosis

  https://www.medindia.net/health/conditions/interstitial-cystitis-diagnosis.htm

  In this test a sample of urine of the patient is centrifuged and the sediments are seen under the microscope. It is a useful test to rule out malignancy of the bladder. […] During cytoscopy, a cytoscope, is used to see the bladder clearly and to study its abnormalities, if any. […] To rule out cancer a piece of the bladder tissue is removed (biopsy), during cytoscopy, to be studied under the microscope. […] Biopsy in Grade II to IV – if done normally may reveal a certain pattern of changes that indicates it to be a case of IC. These changes includes- Presence of Mast cell count in lamina propria, Complete loss of urothelial lining, Granulation tissue in lamina propria, Increase in vascular density in lamina propria on factor VIII (F8) stain.

• #59 :: International Neurourology Journal

  https://www.einj.org/m/journal/view.php?number=570

  The final step is the classification of BPS. The positive cystoscopic findings of BPS are grade 23 glomerulations, Hunners lesions, or both. The positive histologic evidence of BPS includes inflammatory infiltrate and/or granulation tissue and/or detrusor mastocytosis and/or intrafascicular fibrosis. […] At this time, IC/BPS remains a diagnosis of exclusion. Independent of ESSIC recommendations, the first line of diagnosis is patient selection based on symptoms and an exclusion of other diseases with similar presentation. In addition, cystoscopy and biopsy can help with confirmation and classification. Finally, updated pathophysiologic knowledge including numerous urinary biomarkers has led to changes in the diagnostic criteria.

• #60 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  No pathognomonic histologic findings exist for interstitial cystitis, although some authors have found increased numbers of mast cells in the detrusor muscle or submucosa in affected individuals. […] Some authors have found that certain subgroups of patients with interstitial cystitis have increased urothelial permeability to certain intravesical constituents. […] Urinalysis results are usually normal. […] Urodynamic studies are not part of the routine evaluation for interstitial cystitis. […] Pain with bladder filling that reproduces the patients’ interstitial cystitis symptoms is very supportive of a diagnosis of interstitial cystitis.

• #61 Etiology, Pathogenesis, and Diagnosis of Interstitial Cystitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1476007/

  However, at least one quarter (25%) of patients with IC (with either clinical or NIH-NIDDK research criteria) will remain undiagnosed if the KCl test is the sole diagnostic modality. […] The current consensus is that urodynamic evaluation is not required for diagnosis of IC but may provide useful information regarding the differential diagnosis of painful voiding disorders and the symptoms of the overactive bladder. […] Bladder biopsy is not required for the diagnosis of IC, as there are no pathognomonic histological features of the disease. […] The search for noninvasive techniques for diagnosis of IC has led to the study of urinary markers. […] The undue reliance on the NIH-NIDDK criteria for diagnosis has led to significant underdiagnosis of IC as shown by the ICDB Study. […] The previously rigid, monolithic approach to diagnosis employing the NIH-NIDDK criteria is no longer tenable, as clinicians increasingly rely on clinical diagnosis. […] Currently, there is no diagnostic tool for IC that has universal applicability.

• #62 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  No pathognomonic histologic findings exist for interstitial cystitis, although some authors have found increased numbers of mast cells in the detrusor muscle or submucosa in affected individuals. […] Some authors have found that certain subgroups of patients with interstitial cystitis have increased urothelial permeability to certain intravesical constituents. […] Urinalysis results are usually normal. […] Urodynamic studies are not part of the routine evaluation for interstitial cystitis. […] Pain with bladder filling that reproduces the patients’ interstitial cystitis symptoms is very supportive of a diagnosis of interstitial cystitis.

• #63 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  No pathognomonic histologic findings exist for interstitial cystitis, although some authors have found increased numbers of mast cells in the detrusor muscle or submucosa in affected individuals. […] Some authors have found that certain subgroups of patients with interstitial cystitis have increased urothelial permeability to certain intravesical constituents. […] Urinalysis results are usually normal. […] Urodynamic studies are not part of the routine evaluation for interstitial cystitis. […] Pain with bladder filling that reproduces the patients’ interstitial cystitis symptoms is very supportive of a diagnosis of interstitial cystitis.

• #64 Interstitial cystitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/diagnosis-treatment/drc-20354362

  Diagnosis of interstitial cystitis might include: […] Your health care provider may ask you to describe your symptoms and to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass. […] During a pelvic exam, your provider examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. […] A sample of your urine is analyzed for signs of a urinary tract infection. […] Your provider inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. […] During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. […] Your provider collects a urine sample and examines the cells to help rule out cancer. […] Your provider places (instills) two solutions water and potassium chloride into your bladder, one at a time. […] If you feel noticeably more pain or urgency with the potassium solution than with the water, your provider may diagnose interstitial cystitis.

• #65 Interstitial Cystitis (IC): Causes, Diagnosis & Treatment

  https://atlanticurologyclinics.com/conditions/interstitial-cystitis/

  This test assesses how well the bladder and urethra store and release urine. It can help identify any dysfunction in these processes. […] In this test, water and potassium chloride are put into the bladder. Increased pain or urgency with the potassium solution, but not with water, may indicate interstitial cystitis. […] While these diagnostic tools provide valuable information, no single test can definitively diagnose interstitial cystitis. A combination of tests and the physicians clinical judgment leads to the diagnosis.

• #66 Interstitial cystitis: Simplified diagnosis and treatment

  https://www.contemporaryobgyn.net/view/interstitial-cystitis-simplified-diagnosis-and-treatment

  Higher screening scores correlate most closely with the diagnosis of IC. […] The potassium sensitivity test (PST) was developed to aid in the diagnosis of IC. […] Although the PST can be useful, false-positive and false-negative results are possible, and the test can be uncomfortable and irritating for the patient. Thus, it is no longer recommended for routine diagnosis of IC. […] For patients with a PUF questionnaire score greater than 10 to 15, and a history, review of symptoms, and exam suggestive of IC, administering the ABC as a confirmatory test should be considered. […] Patients should be told to schedule a follow-up visit to confirm the diagnosis. […] In the absence of infection, temporary improvement in symptoms for several hours or days after administration of the ABC can be used to support the diagnosis and justify the initiation of therapy.

• #67 Etiology, Pathogenesis, and Diagnosis of Interstitial Cystitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1476007/

  However, at least one quarter (25%) of patients with IC (with either clinical or NIH-NIDDK research criteria) will remain undiagnosed if the KCl test is the sole diagnostic modality. […] The current consensus is that urodynamic evaluation is not required for diagnosis of IC but may provide useful information regarding the differential diagnosis of painful voiding disorders and the symptoms of the overactive bladder. […] Bladder biopsy is not required for the diagnosis of IC, as there are no pathognomonic histological features of the disease. […] The search for noninvasive techniques for diagnosis of IC has led to the study of urinary markers. […] The undue reliance on the NIH-NIDDK criteria for diagnosis has led to significant underdiagnosis of IC as shown by the ICDB Study. […] The previously rigid, monolithic approach to diagnosis employing the NIH-NIDDK criteria is no longer tenable, as clinicians increasingly rely on clinical diagnosis. […] Currently, there is no diagnostic tool for IC that has universal applicability.

• #68 Interstitial cystitis: Simplified diagnosis and treatment

  https://www.contemporaryobgyn.net/view/interstitial-cystitis-simplified-diagnosis-and-treatment

  Higher screening scores correlate most closely with the diagnosis of IC. […] The potassium sensitivity test (PST) was developed to aid in the diagnosis of IC. […] Although the PST can be useful, false-positive and false-negative results are possible, and the test can be uncomfortable and irritating for the patient. Thus, it is no longer recommended for routine diagnosis of IC. […] For patients with a PUF questionnaire score greater than 10 to 15, and a history, review of symptoms, and exam suggestive of IC, administering the ABC as a confirmatory test should be considered. […] Patients should be told to schedule a follow-up visit to confirm the diagnosis. […] In the absence of infection, temporary improvement in symptoms for several hours or days after administration of the ABC can be used to support the diagnosis and justify the initiation of therapy.

• #69 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Interstitial cystitis/painful bladder syndrome affects more than 1 million persons in the United States, but the cause remains unknown. […] Tests and tools commonly used to diagnose interstitial cystitis/painful bladder syndrome include specific questionnaires developed to assess the condition, the potassium sensitivity test, the anesthetic bladder challenge, and cystoscopy with hydrodistension. […] There is no reference standard test for the diagnosis of interstitial cystitis/painful bladder syndrome. Adding to the complexity of diagnosis, numerous conditions have overlapping symptoms. […] The potassium sensitivity test is widely used to aid in the diagnosis of interstitial cystitis/painful bladder syndrome, although it is not universally accepted. […] An anesthetic solution such as buffered lidocaine (Xylocaine) can be instilled in a symptomatic patient. Pain relief suggests that the bladder is the source of the pain.

• #70 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Interstitial cystitis/painful bladder syndrome affects more than 1 million persons in the United States, but the cause remains unknown. […] Tests and tools commonly used to diagnose interstitial cystitis/painful bladder syndrome include specific questionnaires developed to assess the condition, the potassium sensitivity test, the anesthetic bladder challenge, and cystoscopy with hydrodistension. […] There is no reference standard test for the diagnosis of interstitial cystitis/painful bladder syndrome. Adding to the complexity of diagnosis, numerous conditions have overlapping symptoms. […] The potassium sensitivity test is widely used to aid in the diagnosis of interstitial cystitis/painful bladder syndrome, although it is not universally accepted. […] An anesthetic solution such as buffered lidocaine (Xylocaine) can be instilled in a symptomatic patient. Pain relief suggests that the bladder is the source of the pain.

• #71 Interstitial cystitis: Simplified diagnosis and treatment

  https://www.contemporaryobgyn.net/view/interstitial-cystitis-simplified-diagnosis-and-treatment

  Higher screening scores correlate most closely with the diagnosis of IC. […] The potassium sensitivity test (PST) was developed to aid in the diagnosis of IC. […] Although the PST can be useful, false-positive and false-negative results are possible, and the test can be uncomfortable and irritating for the patient. Thus, it is no longer recommended for routine diagnosis of IC. […] For patients with a PUF questionnaire score greater than 10 to 15, and a history, review of symptoms, and exam suggestive of IC, administering the ABC as a confirmatory test should be considered. […] Patients should be told to schedule a follow-up visit to confirm the diagnosis. […] In the absence of infection, temporary improvement in symptoms for several hours or days after administration of the ABC can be used to support the diagnosis and justify the initiation of therapy.

• #72 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Cystoscopy with hydrodistension under anesthesia has been widely used for diagnosis of interstitial cystitis/painful bladder syndrome based on the 1987 NIDDK diagnostic criteria. […] Bladder biopsies are not performed routinely in the United States, although they are widely used to diagnose interstitial cystitis/painful bladder syndrome in Europe. […] The symptoms of interstitial cystitis/painful bladder syndrome often mimic urinary tract infection, but cultures are negative. […] There are two symptom screening questionnaires available for use in office practice: the O’Leary-Sant Symptom and Problem Index and the Pelvic Pain and Urgency/Frequency Symptom Scale (PUF). […] The examination should include a bimanual pelvic examination in women and digital rectal examination in men. Examination of patients with interstitial cystitis/painful bladder syndrome may reveal pelvic floor spasms, rectal spasms, or suprapubic tenderness.

• #73 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Cystoscopy with hydrodistension under anesthesia has been widely used for diagnosis of interstitial cystitis/painful bladder syndrome based on the 1987 NIDDK diagnostic criteria. […] Bladder biopsies are not performed routinely in the United States, although they are widely used to diagnose interstitial cystitis/painful bladder syndrome in Europe. […] The symptoms of interstitial cystitis/painful bladder syndrome often mimic urinary tract infection, but cultures are negative. […] There are two symptom screening questionnaires available for use in office practice: the O’Leary-Sant Symptom and Problem Index and the Pelvic Pain and Urgency/Frequency Symptom Scale (PUF). […] The examination should include a bimanual pelvic examination in women and digital rectal examination in men. Examination of patients with interstitial cystitis/painful bladder syndrome may reveal pelvic floor spasms, rectal spasms, or suprapubic tenderness.

• #74 Interstitial cystitis – Wikipedia

  https://en.wikipedia.org/wiki/Interstitial_cystitis

  They also propose a ranking system based upon the physical findings in the bladder. […] Widely recognized scoring systems such as the O’Leary Sant symptom and problem score have emerged to evaluate the severity of IC symptoms such as pain and urinary symptoms. […] The symptoms of IC/BPS are often misdiagnosed as a urinary tract infection. […] IC/BPS is commonly misdiagnosed as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men, and endometriosis and uterine fibroids (in women).

• #75 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Cystoscopy with hydrodistension under anesthesia has been widely used for diagnosis of interstitial cystitis/painful bladder syndrome based on the 1987 NIDDK diagnostic criteria. […] Bladder biopsies are not performed routinely in the United States, although they are widely used to diagnose interstitial cystitis/painful bladder syndrome in Europe. […] The symptoms of interstitial cystitis/painful bladder syndrome often mimic urinary tract infection, but cultures are negative. […] There are two symptom screening questionnaires available for use in office practice: the O’Leary-Sant Symptom and Problem Index and the Pelvic Pain and Urgency/Frequency Symptom Scale (PUF). […] The examination should include a bimanual pelvic examination in women and digital rectal examination in men. Examination of patients with interstitial cystitis/painful bladder syndrome may reveal pelvic floor spasms, rectal spasms, or suprapubic tenderness.

• #76 Interstitial cystitis: Simplified diagnosis and treatment

  https://www.contemporaryobgyn.net/view/interstitial-cystitis-simplified-diagnosis-and-treatment

  Higher screening scores correlate most closely with the diagnosis of IC. […] The potassium sensitivity test (PST) was developed to aid in the diagnosis of IC. […] Although the PST can be useful, false-positive and false-negative results are possible, and the test can be uncomfortable and irritating for the patient. Thus, it is no longer recommended for routine diagnosis of IC. […] For patients with a PUF questionnaire score greater than 10 to 15, and a history, review of symptoms, and exam suggestive of IC, administering the ABC as a confirmatory test should be considered. […] Patients should be told to schedule a follow-up visit to confirm the diagnosis. […] In the absence of infection, temporary improvement in symptoms for several hours or days after administration of the ABC can be used to support the diagnosis and justify the initiation of therapy.

• #77 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Guideline Statement 6: Efficacy of treatment should be periodically reassessed, and ineffective treatments should be stopped. Clinical Principle […] Guideline Statement 7: Multimodal pain management approaches (e.g., pharmacological, stress management, manual therapy if available) should be initiated. Pain management should be continually assessed for effectiveness because of its importance to quality of life. If pain management is inadequate, then consideration should be given to a multidisciplinary approach and the patient referred appropriately. Clinical Principle […] Guideline Statement 8: The IC/BPS diagnosis should be reconsidered if no improvement occurs after multiple treatment approaches. Clinical Principle […] Guideline Statement 9: Patients should be educated about normal bladder function, what is known and not known about IC/BPS, the benefits versus risks/burdens of the available treatment alternatives, the fact that no single treatment has been found effective for the majority of patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved. Clinical Principle

• #78 Interstitial cystitis: Algorithm to simplify diagnosis of chronic urinary symptoms

  https://www.npwomenshealthcare.com/interstitial-cystitis-simplify-diagnosis/

  The knowledge-to-action (KTA) model provided a conceptual framework for the researcher to develop an evidence-based algorithm for documentation and diagnosis of chronic urinary symptoms, including IC. Using the KTA model, researchers and clinicians follow a sequence of phases in order to optimize knowledge translation across various fields of practice, with the goal of improving health outcomes. Knowledge tools/ products such as clinical practice guidelines, decision aids, and algorithms are developed after review of evidence pertinent to the topic. Once the authors accumulated and evaluated IC research and carefully reviewed evidence-based guidelines, a diagnostic tool was developed using an algorithm format. A Centricity electronic health record (EHR) template was constructed from the algorithm.

• #79 :: International Neurourology Journal

  https://www.einj.org/m/journal/view.php?number=570

  Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by bladder discomfort, urinary frequency, urgency, and pelvic pain. […] The etiology and pathogenesis of this condition is still unknown and remains diagnosed by exclusion. […] The diagnosis of this condition was originally based on these symptomsbladder pain, urinary urgency, and evidence of supportive bladder pathology on cystoscopy under anesthesia (inflammatory infiltrate, granulation tissue, detrusor mastocytosis, intrafascicular fibrosis, and Hunners ulcers), and exclusion of other possible diagnoses. […] The ESSIC suggests an optimal modality for diagnosing IC/BPS using the 3-step-process described below. The first step is the selection of patients. It was agreed that BPS would be diagnosed based on chronic (6 months) pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder. The second step is exclusion of similar diseases through medical history, physical examination, urinalysis, urine cultures, prostate-specific antigen in males 40 years, uroflowmetry, postvoid residual urine volume by ultrasound scanning, cystoscopy, and biopsy.

• #80 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Guideline Statement 1: The basic assessment should include a careful history, physical examination, and laboratory examination to document symptoms and signs that characterize IC/BPS and exclude other disorders that could be the cause of the patient’s symptoms. Clinical Principle […] Guideline Statement 2: Baseline voiding symptoms and pain levels should be obtained in order to measure subsequent treatment effects. Clinical Principle […] Guideline Statement 3: Cystoscopy and/or urodynamics should be considered when the diagnosis is in doubt; these tests are not necessary for making the diagnosis in uncomplicated presentations. Expert Opinion […] Guideline Statement 4: Cystoscopy should be performed in patients for whom Hunner lesions are suspected. Expert Opinion […] Guideline Statement 5: Treatment decisions should typically be made after shared decision-making, with the patient informed of the risks, potential benefits, and alternatives. Except for patients with Hunner lesions, initial treatment should be nonsurgical. Expert Opinion

• #81 Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-interstitial-cystitis-bladder-pain-syndrome-beyond-the-basics/print

  Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics) […] The diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) is based on a person’s symptoms and examination. A careful medical history, physical examination, and, sometimes, laboratory testing are needed to confirm the diagnosis and also to be sure that another condition (eg, bladder infection or kidney stone) is not the cause of symptoms. There is no single test that can definitively diagnose IC/BPS. […] Physical examination — The physical examination usually includes a complete pelvic examination with a brief rectal examination. Often, patients with IC/BPS have tenderness in the lower abdomen, hips, and buttocks. […] If an examination is too uncomfortable, some health care providers recommend that the patient begin a course of treatment for IC/BPS without further testing. If improvement is not seen, it may be necessary to perform more testing to confirm the diagnosis.

• #82 Interstitial Cystitis Workup: Approach Considerations, Cystoscopy, Bladder Biopsy

  https://emedicine.medscape.com/article/2055505-workup

  The diagnosis of interstitial cystitis is most often made when long-standing urinary frequency, urgency, and pelvic pain exist in the absence of a readily identifiable etiology, such as urinary tract infection (UTI). Urinalysis and urine culture are mandatory. A voiding diary is helpful in establishing baseline voiding frequency. […] Cystoscopy is considered by some clinicians to be mandatory in order to diagnose interstitial cystitis However, this is somewhat controversial because of the lack of specific or pathognomonic findings (except perhaps the very rare finding of a Hunner ulcer). […] Urodynamic evaluation is optional, and finding detrusor overactivity or pelvic floor dysfunction may suggest an alternative diagnosis. […] No known radiographic, ultrasonographic, or other imaging findings are specific for interstitial cystitis.

• #83 Interstitial Cystitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15735-interstitial-cystitis-painful-bladder-syndrome

  How is interstitial cystitis/bladder pain syndrome diagnosed? There arent any specific tests to diagnose interstitial cystitis/bladder pain syndrome. However, a healthcare provider will order tests to rule out other infections or conditions. These tests may include: […] A healthcare provider may ask you to record your symptoms in a journal or diary. They may also ask you to record what you drink, how much you drink and how much you pee. […] Youll provide a pee sample, and a healthcare provider will examine it under a microscope to look for blood in your pee (hematuria) and signs of an infection, such as organisms, germs, pus or white blood cells. A provider will prescribe antibiotics to treat an infection. A provider may diagnose IC/BPS if your pee is sterile after treatment, but you still have symptoms.

• #84 Interstitial Cystitis/Painful Bladder Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0515/p1175.html

  Cystoscopy with hydrodistension under anesthesia has been widely used for diagnosis of interstitial cystitis/painful bladder syndrome based on the 1987 NIDDK diagnostic criteria. […] Bladder biopsies are not performed routinely in the United States, although they are widely used to diagnose interstitial cystitis/painful bladder syndrome in Europe. […] The symptoms of interstitial cystitis/painful bladder syndrome often mimic urinary tract infection, but cultures are negative. […] There are two symptom screening questionnaires available for use in office practice: the O’Leary-Sant Symptom and Problem Index and the Pelvic Pain and Urgency/Frequency Symptom Scale (PUF). […] The examination should include a bimanual pelvic examination in women and digital rectal examination in men. Examination of patients with interstitial cystitis/painful bladder syndrome may reveal pelvic floor spasms, rectal spasms, or suprapubic tenderness.

• #85 Diagnosing interstitial cystitis: Tests and when to seek help

  https://www.medicalnewstoday.com/articles/how-is-interstitial-cystitis-diagnosed

  A urine cytology test screens a persons urine for abnormal or cancerous cells. […] Urologists may order these tests if a person experiences frequent burning or stinging sensations during urination, has blood in their urine, or experiences pain while urinating. […] A cystoscopy is a diagnostic procedure in which a urologist inserts a thin tube called a cystoscope into a persons urethra. […] This tool allows the urologist to view the bladder and urethra to look for inflammation or swelling, bladder ulcers, and signs of infection. […] According to the Interstitial Cystitis Association, cystoscopy with hydrodistension is no longer the standard method of diagnosing IC/BPS. […] However, this procedure can help identify Hunners lesions, which are painful ulcers or patches that appear on the bladder wall in 510% of people with IC/BPS.

• #86 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Guideline Statement 1: The basic assessment should include a careful history, physical examination, and laboratory examination to document symptoms and signs that characterize IC/BPS and exclude other disorders that could be the cause of the patient’s symptoms. Clinical Principle […] Guideline Statement 2: Baseline voiding symptoms and pain levels should be obtained in order to measure subsequent treatment effects. Clinical Principle […] Guideline Statement 3: Cystoscopy and/or urodynamics should be considered when the diagnosis is in doubt; these tests are not necessary for making the diagnosis in uncomplicated presentations. Expert Opinion […] Guideline Statement 4: Cystoscopy should be performed in patients for whom Hunner lesions are suspected. Expert Opinion […] Guideline Statement 5: Treatment decisions should typically be made after shared decision-making, with the patient informed of the risks, potential benefits, and alternatives. Except for patients with Hunner lesions, initial treatment should be nonsurgical. Expert Opinion

• #87 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Guideline Statement 1: The basic assessment should include a careful history, physical examination, and laboratory examination to document symptoms and signs that characterize IC/BPS and exclude other disorders that could be the cause of the patient’s symptoms. Clinical Principle […] Guideline Statement 2: Baseline voiding symptoms and pain levels should be obtained in order to measure subsequent treatment effects. Clinical Principle […] Guideline Statement 3: Cystoscopy and/or urodynamics should be considered when the diagnosis is in doubt; these tests are not necessary for making the diagnosis in uncomplicated presentations. Expert Opinion […] Guideline Statement 4: Cystoscopy should be performed in patients for whom Hunner lesions are suspected. Expert Opinion […] Guideline Statement 5: Treatment decisions should typically be made after shared decision-making, with the patient informed of the risks, potential benefits, and alternatives. Except for patients with Hunner lesions, initial treatment should be nonsurgical. Expert Opinion

• #88 Diagnosing interstitial cystitis: Tests and when to seek help

  https://www.medicalnewstoday.com/articles/how-is-interstitial-cystitis-diagnosed

  A bladder wall biopsy is a diagnostic procedure in which a urologist removes a small sample of the bladder tissue for analysis under a microscope. […] A biopsy is not necessary to confirm a diagnosis of IC/BPS, but it can help rule out bladder cancer. […] Healthcare professionals may ask males who are experiencing symptoms of IC/BPS to undergo an examination of prostate secretions to rule out prostatitis an infection and inflammation of the prostate gland that can have similar symptoms to IC/BPS. […] Potassium chloride sensitivity testing (PST) is a controversial diagnostic method for IC/BPS. […] This test involves instilling a persons bladder with water and potassium chloride solution, a known irritant. […] People should consult a doctor about the risks and benefits of a PST. […] IC/BPS is a chronic bladder condition that can affect anyone of any sex. People who suspect that they have IC/BPS should contact a doctor for testing and treatment. […] Getting a diagnosis is the first step toward relief.

• #89 Etiology, Pathogenesis, and Diagnosis of Interstitial Cystitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1476007/

  However, at least one quarter (25%) of patients with IC (with either clinical or NIH-NIDDK research criteria) will remain undiagnosed if the KCl test is the sole diagnostic modality. […] The current consensus is that urodynamic evaluation is not required for diagnosis of IC but may provide useful information regarding the differential diagnosis of painful voiding disorders and the symptoms of the overactive bladder. […] Bladder biopsy is not required for the diagnosis of IC, as there are no pathognomonic histological features of the disease. […] The search for noninvasive techniques for diagnosis of IC has led to the study of urinary markers. […] The undue reliance on the NIH-NIDDK criteria for diagnosis has led to significant underdiagnosis of IC as shown by the ICDB Study. […] The previously rigid, monolithic approach to diagnosis employing the NIH-NIDDK criteria is no longer tenable, as clinicians increasingly rely on clinical diagnosis. […] Currently, there is no diagnostic tool for IC that has universal applicability.

• #90 Interstitial Cystitis Differential Diagnoses

  https://emedicine.medscape.com/article/2055505-differential

  Diagnosing interstitial cystitis remains difficult even more than a century after it was described by Skene, in 1887. No pathognomonic findings exist with regard to patient history, physical examination findings, laboratory findings, or cystoscopy findings. The exclusion of other clinical entities remains the foremost goal of the workup and evaluation of patients thought to have this condition. […] A careful, complete, and empathetic history and physical examination are critical. Cystoscopy is an adjunctive, although important, study. The classic Hunner ulcer in the setting of a small-capacity bladder (ie, assessed under anesthesia) is rarely seen to confirm the diagnosis with certainty. Until interstitial cystitis is defined completely or a definitive marker becomes universally available, the diagnosis remains one of exclusion. […] Clinically, the practitioner is somewhat obligated to consider these potential alternative diagnoses prior to diagnosing interstitial cystitis. The implications of a diagnosis of interstitial cystitis are profound in that it is a chronic condition without universally effective therapy.

• #91 Etiology, Pathogenesis, and Diagnosis of Interstitial Cystitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1476007/

  However, at least one quarter (25%) of patients with IC (with either clinical or NIH-NIDDK research criteria) will remain undiagnosed if the KCl test is the sole diagnostic modality. […] The current consensus is that urodynamic evaluation is not required for diagnosis of IC but may provide useful information regarding the differential diagnosis of painful voiding disorders and the symptoms of the overactive bladder. […] Bladder biopsy is not required for the diagnosis of IC, as there are no pathognomonic histological features of the disease. […] The search for noninvasive techniques for diagnosis of IC has led to the study of urinary markers. […] The undue reliance on the NIH-NIDDK criteria for diagnosis has led to significant underdiagnosis of IC as shown by the ICDB Study. […] The previously rigid, monolithic approach to diagnosis employing the NIH-NIDDK criteria is no longer tenable, as clinicians increasingly rely on clinical diagnosis. […] Currently, there is no diagnostic tool for IC that has universal applicability.

• #92 Wrong Diagnosis | Interstitial Cystitis Association

  https://www.ichelp.org/understanding-ic/diagnosis/wrong-diagnosis/

  Diagnosing IC/BPS can be challenging. […] The IC/BPS diagnosis process requires healthcare providers to rule out other conditions prior to making the clinical judgment that you have IC/BPS. […] IC/BPS is often mistaken for a urinary tract infection (UTI) or bladder infection, which it is not. […] The diagnosis of IC/BPS and overactive bladder (OAB) are easy to confuse. […] IC/BPS and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are conditions in men that are similar. […] You might confuse hemorrhagic cystitis with IC/BPS because the symptoms are similar. […] Controversy swirls around the idea that pudendal nerve problems might be mistaken for IC/BPS or maybe cause it and that surgery to fix it may be the best option. […] Much of the research about the causes of IC/BPS is striving to sort out the overlap of IC/BPS with other chronic conditions such as allergies, irritable bowel syndrome, and sensitive skin are three common overlapping conditions in the IC/BPS population. […] Diagnosing Complicated IC/BPS Cases.

• #93 Interstitial Cystitis (IC): Causes, Diagnosis & Treatment

  https://atlanticurologyclinics.com/conditions/interstitial-cystitis/

  Diagnosing IC can be challenging due to the variability of symptoms and the lack of a definitive test for the condition. […] Here are some steps typically taken to arrive at a diagnosis of IC: […] A comprehensive medical history is collected to understand the patients symptoms, frequency, severity, and potential triggers. […] These tests help rule out urinary tract infections or other conditions with similar symptoms to interstitial cystitis. […] The patient may be asked to keep a detailed diary to record the amounts of fluid intake, frequency and volume of urination, and when pain occurs. […] This procedure involves inserting a thin tube with a camera (a cystoscope) into the urethra to examine the bladder and possibly perform a biopsy. Cystoscopy can help identify bladder abnormalities, such as Hunners ulcers, which are found in some individuals with interstitial cystitis.

• #94 Interstitial Cystitis/Bladder Pain Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/132252

  Neither cystoscopy nor urodynamics is required to diagnose IC/BPS according to the AUA guidelines. Neither is diagnostic, but they may be appropriate if the diagnosis is in doubt. […] Cystoscopy primarily rules out malignancy, strictures, Hunner ulcers, and bladder outlet obstruction. […] A Hunner ulcer is characteristic and diagnostic of classic IC. […] Patients with Hunner ulcers generally respond well to treatment. […] Patients who do not respond adequately to the above treatments may be candidates for the following: Botulinum toxin A detrusor injections, Cyclosporine A, Neuromodulation, Misoprostol (oral or intravesical), Tibial nerve stimulation. […] Definitive surgical therapy is reserved for patients who continue to have significant symptoms that have not been adequately controlled with any of the listed alternative treatments.

• #95 Interstitial cystitis: Simplified diagnosis and treatment

  https://www.contemporaryobgyn.net/view/interstitial-cystitis-simplified-diagnosis-and-treatment

  Higher screening scores correlate most closely with the diagnosis of IC. […] The potassium sensitivity test (PST) was developed to aid in the diagnosis of IC. […] Although the PST can be useful, false-positive and false-negative results are possible, and the test can be uncomfortable and irritating for the patient. Thus, it is no longer recommended for routine diagnosis of IC. […] For patients with a PUF questionnaire score greater than 10 to 15, and a history, review of symptoms, and exam suggestive of IC, administering the ABC as a confirmatory test should be considered. […] Patients should be told to schedule a follow-up visit to confirm the diagnosis. […] In the absence of infection, temporary improvement in symptoms for several hours or days after administration of the ABC can be used to support the diagnosis and justify the initiation of therapy.

• #96 Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022)

  Guideline Statement 6: Efficacy of treatment should be periodically reassessed, and ineffective treatments should be stopped. Clinical Principle […] Guideline Statement 7: Multimodal pain management approaches (e.g., pharmacological, stress management, manual therapy if available) should be initiated. Pain management should be continually assessed for effectiveness because of its importance to quality of life. If pain management is inadequate, then consideration should be given to a multidisciplinary approach and the patient referred appropriately. Clinical Principle […] Guideline Statement 8: The IC/BPS diagnosis should be reconsidered if no improvement occurs after multiple treatment approaches. Clinical Principle […] Guideline Statement 9: Patients should be educated about normal bladder function, what is known and not known about IC/BPS, the benefits versus risks/burdens of the available treatment alternatives, the fact that no single treatment has been found effective for the majority of patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved. Clinical Principle

• #97 INTERSTITIAL CYSTITIS: The gynecologist’s guide to diagnosis | MDedge

  https://www.mdedge.com/obgyn/article/63961/interstitial-cystitis-gynecologists-guide-diagnosis

  Don’t overlook this disease when a patient complains of pelvic pain. As many as 85% of women who seek care for chronic pelvic pain have interstitial cystitis and painful bladder syndrome, studies show—instead of, or in addition to, a gynecologic diagnosis. […] Early diagnosis and treatment appear to improve the response to treatment and prevent progression to severe disease. Because the gynecologist is the physician who commonly sees women at the onset of chronic pelvic pain, he or she is ideally positioned to diagnose this disorder early in its course. […] Although interstitial cystitis (IC) occurs in the absence of urinary tract infection or malignancy, some pathology may become apparent during cystoscopy with hydrodistention. Potential findings include: (A) glomerulations, or hemorrhages of the bladder mucosa (B) damage to the urothelium (C) Hunner’s ulcer, a defect of the urothelium that is pathognomonic for IC but uncommon.

• #98 Interstitial Cystitis/Bladder Pain Syndrome: Diagnosis and Subtypes

  https://pelvicpainrehab.com/blog/interstitial-cystitis-bladder-pain-syndrome-diagnosis-and-subtypes/

  Interstitial Cystitis/Bladder Pain Syndrome is defined as […] An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes. […] Most people diagnosed with Interstitial Cystitis/Bladder Pain Syndrome are diagnosed based on symptoms alone without a proper workup from a provider to find the root cause, aside from possibly ruling out an infection. […] The AUA updated their guidelines in 2022 defining the diagnosis as primarily a neuromuscular disorder rather than a bladder disease. Five subgroups were used to describe the diagnosis and classification to help navigate appropriate treatments, and in 2022 there was further expansion into nine distinct phenotypes to further improve treatment approaches. […] While these subgroups help to better understand where the pain is coming from in order to approach treatment, a thorough workup is still needed to best understand the factors contributing to symptoms in each individual case.

• #99

  https://journals.lww.com/ursc/fulltext/2021/32010/toward_a_validated_diagnostic_test_with_machine.2.aspx

  IC/BPS is currently diagnosed by urinary symptoms and pain levels, as well as physical examination. There is currently no commercial biomarker test available. […] The diagnostic tool we are developing is the IC-risk score (IC-RS), which may aid clinicians and researchers in classifying IC/BPS patients, track disease progression, and possibly determine response to therapy. […] Our current research aims to build a new ML RS to distinguish all IC/BPS participants (both NHIC and HIC) from controls, the IC-RS. […] The IC-RS ML classifier was trained using data obtained in our previous urine collection. This RFC binary classifier will categorize subjects as either having or not having IC/BPS based on the levels of measured cytokines and OPSI score. […] The result of this research is hopefully a diagnostic product that will be the first regulatory approved clinical laboratory test for IC/BPS. […] We believe a great part of the future of health care is computer science based and SaMD can play an important role.

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