Painful bladder syndrome

Abstract

Painful bladder syndrome/interstitial cystitis (PBS/IC), also known as bladder pain syndrome (BPS/IC), is primarily based on symptoms of urgency, frequency, and pain in the bladder and/or pelvis. Its etiology is not known and clinical characteristics vary among patients. Early recognition of BPS/IC is very important because the symptoms are quite disabling, affecting quality of life and resulting in patients being visited by a variety of specialists. Several and controversial etiologic theories have been proposed but one aspect has been emphasised: the multifactorial etiology of the disease. Physical evaluation is a critical component of diagnosing BPS/IC. Questionnaires can be helpful in screening. The most commonly used screening tools are the Pelvic Pain, Urgency, Frequency patient questionnaire (PUF) and O'Leary-Sant Symptom and Problem Index. Local cystoscopy is not mandatory but is a good preliminary investigation to rule out other conditions. Cystoscopy with hydrodistension under anesthesia is now considered too restrictive, however it remains the most common procedure performed in patients with BPS/IC especially in Europe. There are currently no specific blood or urine markers available for diagnosis. The therapeutic strategy is to reduce or eliminate the symptoms of BPS/IC, so improving quality of life and interfering with the potential disease mechanism. Therapies include conservative, medical (oral, subcutaneous, and intravesical), or interventional procedures. A multimodal approach seems to be more effective. A surgical approach should be the ultimate option for refractory BPS/IC patients. © 2010 Springer-Verlag Milan.