The Diagnostic and Treatment Patterns of Urologists in the United States for Interstitial Cystitis/Painful Bladder Syndrome

Abstract

Introduction Interstitial cystitis/bladder pain syndrome is not completely understood, making it challenging to diagnose and treat. The current literature elucidating this disease process is inconsistent. Without a clear consensus regarding management it is important to evaluate how urologists are treating these patients. Methods Urologists across the United States completed a 19-item survey addressing diagnostic and treatment methods for interstitial cystitis. Participation was voluntary and no compensation was provided to complete the survey. Results A total of 95 surveys were completed and returned between December 2012 and January 2013. Of the respondents 92% considered themselves general urologists and most preferred to manage interstitial cystitis/bladder pain syndrome themselves with only 33% referring these patients. Of the respondents 47% believed that the etiology of interstitial cystitis is still unknown. Cystoscopy with hydrodistention was the most common approach to diagnosis (70% of respondents) followed closely by validated symptoms scores (65%). Oral medication was the most commonly used treatment (92% of respondents), of which pentosan polysulfate was the most commonly used agent. Oral medication was followed by intravesical treatment and bladder hydrodistention at 77% and 74% of respondents, respectively. Most urologists ultimately used multimodal therapy. AUA (American Urological Association) guidelines were followed by only 15% of respondent urologists. Conclusions The treatment of patients with interstitial cystitis/bladder pain syndrome is variable and many urologists use multiple modalities for diagnosis and treatment. This variability in diagnosis and/or treatment reflects the deficiency of our current understanding of this disease process. Until the pathophysiology is better delineated diagnosis and treatment will remain without consensus.