The Future of Pharmacologic Treatment for Bladder Pain Syndrome/Interstitial Cystitis: Lessons From a Meta-Analysis

Abstract

The paper by Giannantoni et al in this issue of European Urology [1] is certainly an important scientific document, but it also provides overwhelming evidence for urgent profound reflection on the direction of study of bladder pain syndrome/interstitial cystitis (BPS/IC) treatment. It is timely because, fortunately, there is increasing interest in uncovering the pathophysiology of and an effective treatment for this mysterious disease. It gives readers comprehensive information about the literature on BPS/IC. For investigators new to this area, easy access to a complete review on the topic may help identify new paths to explore and new research priorities. In addition, thismanuscript shows that a consensus about the definitions to be used in the next round of BPS/IC randomized controlled trials (RCTs) must be urgently established. A fundamental step in the understanding of BPS/IC is agreement on a single, clear definition. This has not been possible in the past as different definitions were advanced by the International Continence Society Terminology Committee [2], by the European Society for the Study of Interstitial Cystitis (ESSIC) [3], and, more recently, by the American Urological Association [4]. The possible inclusion of urgency in the BPS/IC symptom complex is major issue around which a consensus should be built, particularly if, in the minimal work-up required for diagnosis, cystoscopy with hydrodistention is to be omitted. A significant overlap between BPS/IC and overactive bladder (OAB) might occur, bringing unnecessary noise to the trials’ patient cohorts. In this respect I believe that a plea for a consensus around the classification forwarded by ESSIC [3], based on cystoscopic findings after bladder hydrodistention and on the biopsy report given by a trained pathologist, could be a fundamental step for