Diagnosis Of Interstitial Cystitis Research Articles

Definition Change and Update of Clinical Guidelines for Interstitial Cystitis and Bladder Pain Syndrome.

The clinical guidelines for interstitial cystitis (IC) and bladder pain syndrome (BPS) have been revised by updating our previous guidelines. The symptoms of IC and BPS, collectively called as hypersensitive bladder (HSB) symptoms, are virtually indistinguishable between IC and BPS; however, IC and BPS should be considered as a separate entity of disorders. We define IC as a bladder disease with Hunner lesions, usually associated with HSB symptoms and bladder inflammation, and BPS as a condition with HSB symptoms in the absence of Hunner lesions and any confusable diseases. Pathophysiology totally differs between IC and BPS. IC involves immunological inflammation probably resulting from autoimmunity, while BPS is associated with the interaction of multiple factors such as neurogenic inflammation, exogenous substances, urothelial defects, psychological stress, and neural hyperactivity. Histopathology also differs between IC and BPS. IC is associated with severe inflammation of the whole bladder accompanied by plasma cell infiltration and urothelial denudation, while BPS shows little pathological changes. Management should begin with a differential diagnosis of IC or BPS, which would require cystoscopy to determine the presence or absence of Hunner lesions. The patients should be treated differently based on the diagnosis following the algorithm, although pain management would be common to IC and BPS. Clinical studies are also to be designed and analyzed separately for IC and BPS.

Intravesical Interferon Therapy vs Hyaluronic Acid for Pain Among Female Individuals With Interstitial Cystitis

Interstitial cystitis (IC) is a debilitating condition. Although viral infection is a potential etiological cause, few studies have detected the effect of antiviral treatment. To determine the efficacy and safety of intravesical interferon instillation compared with hyaluronic acid in female patients with IC. This double-masked, randomized phase 2/3 clinical trial with parallel group design was implemented from October 2022 to April 2023 and had a 6-month follow-up period. The study was conducted at a single center. Eligible participants were female patients aged 18 to 70 years with a diagnosis of IC for more than 6 months. The last visit took place in October 2023. Data were analyzed between October and November 2023. Patients were randomized 1:1 to receive either intravesical instillation of interferon or hyaluronic acid. The primary end point was change in visual analog scale pain score. Secondary end points included changes in voiding frequency, functional bladder capacity, symptom index, and global response assessment. Adverse events were closely monitored. Among the 52 patients, the mean (SD) age was 50.0 (14.1) years and they were randomized to either the interferon group (26 [50%]) or hyaluronic acid (26 [50%]). The visual analog pain score showed the interferon group decreased more significantly than hyaluronic acid (-1.3; 95% CI, -2.3 to -0.3; P = .02) at month 6, with 20 patients (77%) exhibiting a 30% or higher reduction in pain compared with baseline. Secondary end points of voiding frequency, functional bladder capacity, and nocturia episodes showed no significant difference between 2 therapies. However, interferon showed a significantly higher reduction in the Interstitial Cystitis Symptom Index (-3.0; 95% CI, -5.3 to -0.7; P = .01) and the Problem Index (-2.5; 95% CI, -4.5 to -0.4; P = .02) at month 6, with 22 patients (85%) presenting as moderately or markedly improved. The frequencies of adverse events were similar between 2 groups. Only 1 patient discontinued hyaluronic acid because of poor effectiveness. In this randomized clinical trial, female patients with IC could benefit from intravesical interferon therapy, without serious adverse events. These results offered hope for antiviral approaches in IC, but larger-scale, multicenter trials and long-term follow-up should be considered. ClinicalTrials.gov Identifier: NCT05912946.

Диагностика и лечение синдрома болезненного мочевого пузыря: результаты опроса врачей урологов РФ.

Introduction. Interstitial cystitis (IC) remains one of the causes of chronic pelvic pain. Current treatment methods do not allow complete control of the patient's symptoms. The lack of uniform diagnostic and treatment algorithms motivates specialists to use the recommendations of communities, which may differ from each other. The purpose of the study is to study the approaches of Russian doctors to the diagnosis and treatment of IC. Material and methods. The Department of Urology of the Russian University of Medicine conducted an observational analytical study from 2022 to 2023: a survey of urologists in order to study the issue of diagnosis and treatment of IC in the Russian Federation. Respondents were asked 25 questions. 86 urologists took part in the survey, 57 of them fully answered all the questions asked. The survey was possible through the online platform SurveyMonkey based on the urological portal Uroweb.ru. Statistical analysis. Methods of descriptive statistics were used for the purpose of data analysis. Results. Specialists from more than 5 regions of the Russian Federation participated in the survey. 33% (19) of the respondents would prefer to use options not recommended by large communities to treat IC. 68% (39) of the respondents reported urinary tract infection in patients with IC. 54% (31) of the respondents would prefer to use cystoscopy under local anesthesia for initial diagnosis. Cystoscopy under general anesthesia is more informative in 81% (46), biopsy is taken by 75% (43) of specialists. The most popular treatments are behavioral and non-pharmacological therapies in 74% (42), therapies aimed at repairing the bladder mucosa in 79% (45), and intravesical pharmacotherapy in 77% (44). Botulinum therapy is used by 66% (38) of specialists. Repeat surgical treatment is suggested after an average of 6-12 months, but there are no minimal intervals. Conclusion. The problem of IC continues to remain relevant and requires not only a revision of the definition, but also improvement of approaches to diagnosis and treatment.

Novel Treatment for Interstitial Cystitis Pilot Study

Background and aims: Use of platelet-rich plasma (PRP) is well established in treatment of orthopedic patients. This pilot study aims to determine the efficacy of using instillation of PRP paired with hydrodistention of the bladder to treat patients with interstitial cystitis (IC). Methods: Patients with a diagnosis of interstitial cystitis were recruited to this study. Patients completed Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale, which quantified a symptom and bother score. Patients were treated with hydrodistention with instillation of PRP. Patients completed the PUF questionnaire weekly for six weeks following treatment. Results: 12 patients underwent hydrodistention with instillation of PRP. The patients were all women, ranging in age from 23 to 71. The mean symptom score went from 13.167 to 7.417 and the mean bother score decreased from 6.833 to 4.41, showing a statistically significant reduction in symptom and bother scores. Conclusions: Hydrodistention with instillation of PRP is an effective treatment of interstitial cystitis.

Cerebral Perfusion and Sensory Testing Results Differ in Interstitial Cystitis/Bladder Pain Syndrome Patients with and without Fibromyalgia: A Site-Specific MAPP Network Study.

PurposeFibromyalgia is a common co-morbidity in patients with interstitial cystitis/bladder pain syndrome. Quantitative sensory testing measures and regional cerebral blood flow measures have been noted to differ from healthy controls in both subjects with fibromyalgia and those with interstitial cystitis when studied independently. The present study examined such measures in subjects with the diagnosis of interstitial cystitis both with and without the co-diagnosis of fibromyalgia to determine whether differences in these measures may be associated with co-morbidity.Patients and MethodsFemale subjects with the diagnosis of interstitial cystitis with (n = 15) and without (n = 19) the co-diagnosis of fibromyalgia as well as healthy control subjects (n = 41) underwent quantitative sensory testing. A subset of these patients (9 with and 9 without fibromyalgia) underwent brain perfusion studies using arterial spin labeled functional magnetic resonance imaging. An analysis was performed of absolute regional cerebral blood flow of regions-of-interest when experiencing a full bladder compared with an empty bladder.ResultsSubjects with both interstitial cystitis and fibromyalgia were more hypersensitive than those without fibromyalgia as well as healthy controls in most sensory measures except heat. Subjects with interstitial cystitis, but no fibromyalgia, differed from healthy controls only in toleration of the ischemic forearm task. Other co-morbidities were more common in those subjects with both interstitial cystitis and fibromyalgia. Bladder fullness was associated with significantly greater whole brain gray matter blood flow in subjects with interstitial cystitis and fibromyalgia when compared with that of subjects with interstitial cystitis without fibromyalgia. Examination of regional cerebral blood flow in individual regions-of-interest demonstrated statistically significant differences between the subjects with interstitial cystitis with and those without fibromyalgia bilaterally in the thalamus, amygdala and hippocampus, as well as the right prefrontal cortex and greater responsiveness to changes in bladder fullness in the insula.ConclusionQuantitative sensory testing and brain perfusion data support that there are two phenotypes of interstitial cystitis patients, which can be differentiated by a co-diagnosis of fibromyalgia. This may affect responsiveness to treatment and suggest the utility of stratifying interstitial cystitis patients according to their co-morbidities.

Diagnosis of interstitial cystitis: practice-orientated diagnostic work-up

Interstitial cystitis is a chronic orphan disease of the urinary bladder characterised by its main symptoms of bladder pain, persistent urge to void and urinary frequency. Due to a variety of confusable diseases and different pathophysiologies, the diagnosis of IC is still a diagnosis of exclusion and remains a challenge for doctors and patients alike. Patients often experience misdiagnosis and unsuccessful treatment for years. Therefore, the primary goal for these patients with chronic pain must be a rapid diagnosis and initiation of adequate treatment. This article focuses on transferring the consensus-based recommendations of the current German S2k guideline "Diagnosis and Treatment of Interstitial Cystitis" (IC/BPS) (2018 AWMF register No.: 043/050) into a practice-orientated and structured diagnostic work-up process.

Interstitial Cystitis/Bladder Pain Syndrome's Correlations with Pregnancy and Neonatal Outcomes: A Study of a Population Database.

Our objective was to evaluate the associations with interstitial cystitis during pregnancy using a United States inpatient database. We conducted a retrospective cohort study utilizing the Nationwide Inpatient Sample database from the Healthcare Cost and Utilization Project. ICD-9 code number 595.1 was used to extract cases of chronic interstitial cystitis and these pregnancies were compared to pregnancies without chronic interstitial cystitis, using the Chi-squared test to evaluate nominal variables. A multivariate logistic regression model was subsequently used to adjust for statistically significant confounders (p value <0.05). There were 9,095,995 deliveries during the study period; 793 pregnant women were found to have chronic interstitial cystitis. When controlling for confounding effects in terms of pregnancy outcomes, the diagnosed group had a greater risk of developing pregnancy-induced hypertension (adjusted OR 1.57, 95% CI 1.21-2.05), preeclampsia (adjusted OR 2.06, 95% CI 1.47-2.87), preterm delivery (adjusted OR 1.63, 95% CI 1.23-2.17), preterm premature rupture of membranes (adjusted OR 2.18, 95% CI 1.25-3.79), chorioamnionitis (adjusted OR 2.05, 95% CI 1.24-3.37), delivery via cesarean section (adjusted OR 1.57, 95% CI 1.32-1.88), maternal infection (adjusted OR 2.19, 95% CI 1.40-3.43), and deep venous thromboembolism (adjusted OR 10.56, 95% CI 3.37-33.09). Interstitial cystitis diagnosis is associated with an increased risk of preeclampsia, preterm birth, and other adverse pregnancy outcomes in this database study. Prospective studies are required to confirm the findings of the correlation between interstitial cystitis and adverse pregnancy outcomes.

Using the Working Model of Adjustment to Chronic Illness to explain the burden of recurrent urinary tract infection: A survey-based study

Abstract Introduction The treatment of recurrent urinary tract infection (RUTI) with antibiotics is causing concern as patients are often prescribed an inappropriate course of antibiotics, and the recurrence rate remains at 30–44% following treatment (1). Overprescription of antibiotics can also cause antimicrobial resistance. Given the current lack of adequate clinical guidelines for RUTI treatment, it is necessary for this population to adjust to living with a chronic condition, and research suggests that RUTI may be associated with poor mental health and a lower quality of life. Thus, there is a need for a more interdisciplinary approach to understanding RUTI, to inform additional treatment options. Aim The current study aimed to use the Working Model of Adjustment to Chronic Illness (WMACI) (see Figure 1) to explore the personal, physical and social burden of RUTI (2). Methods A cross-sectional survey was employed, which was informed by existing questionnaires and reviewed by experts including pain specialists (n = 6). 5,078 participants accessed liveutifree.com to seek information regarding their condition and completed the Live UTI Free survey. Participants provided information on their experiences with RUTI (recurrence rate, symptoms, pain intensity, triggers and comorbidity) and the associated burden. Binomial logistic regressions were conducted to assess the effect of RUTI characteristics on the likelihood of experiencing personal, physical and social burden. Results RUTI predicted greater likelihood of personal burden (enjoyment of life; enjoyment of favourite activities; mental health) (R² = 18.8 – 20.8, p = &amp;lt;.001), physical burden (sleep; activities of daily living; maintaining a healthy lifestyle; sexual behaviour) (R² = 21.1 – 35.9, p = &amp;lt;.001), and social burden (normal work; finances; relationships with friends and family; relationships with partners) (R² = 17.0 - 25.8, p = &amp;lt;.001), with the burden associated with sexual behaviour showing the largest amount of variance. Rate of recurrence, symptom burden, pain intensity, and having an additional diagnosis of Interstitial Cystitis (IC) were most predictive of participant burden. Conclusion RUTI was associated with all areas of burden. Some factors, including pain intensity and having an additional diagnosis of IC, affected a majority of areas. Predicted burden from having an additional diagnosis of IC may be a result of lack of clarity between the two diagnoses, which have shared symptom indicators and rely on urine culture testing, which has been demonstrated to be inaccurate. Misdiagnosis, or a dual diagnosis, may consequently contribute to burden. The WMACI was used to suggest how burden can lead to poor illness adjustment. Limitations of the study were that it did not explore the possibility of misdiagnosis and its impact, or investigate the effects of SES and country-level differences. However, the findings of the study have important clinical implications, as patients worldwide who are suffering with RUTI are required to manage significant burden that is associated with the condition, and this is an important issue which needs to be addressed in primary care settings. An interdisciplinary approach in primary care settings is recommended, which acknowledges the psychosocial burden that persists when treatment fails to resolve physical symptoms.

Pentosan polysulfate maculopathy versus age-related macular degeneration: comparative assessment with multimodal imaging

ObjectiveTo evaluate whether pentosan polysulfate maculopathy manifests distinctive imaging features that can be differentiated from those found in age-related macular degeneration (AMD). MethodsLocal databases were queried to identify patients with a diagnosis of interstitial cystitis who were seen at the Emory Eye Center between May 2014 and January 2019 and who had fundus imaging available for review. Ninety patients met the eligibility criteria. Masked graders categorized patients based on imaging characteristics as follows: category 1: pentosan polysulfate maculopathy; category 2: AMD or drusen; category 3: neither; and category 4: unsure. Pentosan polysulfate exposure characteristics were compared among groups. ResultsOf the 90 subjects evaluated, 79 (88%) were female and the median age was 61.5 years (range, 30–89). Seventeen patients were placed in category 1; 25 in category 2; 47 in category 3, and; 1 in category 4. Among categories 1 to 4, respectively, 17 (100%), 15 (60%), 28 (60%), and 0 patients had exposure to pentosan polysulfate (p = 0.007). Mean cumulative exposure to pentosan polysulfate across the four categories was 2.1, 0.36, 0.34, and 0 kg, respectively (p < 0.00001). Eyes with pentosan polysulfate maculopathy did not have typical drusen in the macula. ConclusionAlthough pentosan polysulfate maculopathy resembles some aspects of AMD, the two conditions can be differentiated with the use of multimodal fundus imaging.

Women's Experiences of Interstitial Cystitis/Painful Bladder Syndrome.

The aim of this study was to explore the lived experience of interstitial cystitis (IC)/painful bladder syndrome (PBS). A phenomenological approach with emphasis on reflection and openness was adopted. Twenty women diagnosed with IC an average of nine years prior to data collection produced a written account of their experiences. The textual data was analyzed using thematic analysis. Four themes were derived from data analysis: diagnostic uncertainty; restrictions and limitations on life; self-management; and interpersonal relationships and social support. Women reported issues in receiving a diagnosis of IC, undergoing numerous diagnostic tests, and experiencing multiple referrals. Having undergone numerous treatments with limited success, women sought information and management strategies outside of standard medical care and reported a negative impact on sexual and social relationships. The findings illustrate the complex nature of women’s experiences and the physical and psychological impacts and effects of IC/PBS on women’s daily lives.

A step toward precision diagnosis of interstitial cystitis

A step toward precision diagnosis of interstitial cystitis

Identification of Patients with Pentosan Polysulfate Sodium-Associated Maculopathy through Screening of the Electronic Medical Record at an Academic Center.

Aims This chart review of a quaternary academic medical center electronic medical record (EMR) aimed to identify patients at risk of development of maculopathy with exposure to pentosan polysulfate sodium (PPS). Methods A review of electronic medical records of a quaternary medical center of patients with either documented exposure to PPS or diagnosis of interstitial cystitis (IC) from 2007 to 2019 was performed for retinal imaging and visual acuity; the study was conducted in August of 2019. Results 216 charts were included for analysis, of which 96 had documented eye exams and 24 had retinal imaging done. We identified three patients with maculopathy in the context of long-term exposure to PPS via chart review, and one additional patient was identified by referral. The median PPS exposure duration was 11 years (range 7 to 19 years). Median logMAR BCVA OD 0.6 range was 0.0–1.9 (approximate Snellen equivalent 20/80 range (20/20–20/1600)) and OS 0.7 range was 0.1–1.9 (approximate Snellen equivalent 20/100 range (20/25–20/1600)). Ultrawidefield color fundus imaging and fundus autofluorescence revealed findings of pigmentary changes and patchy macular atrophy. Optical coherence tomography (OCT) demonstrated outer retinal thinning and increased choroidal transmission coincident with areas of atrophy seen on fundus imaging. Conclusions Less than half of patients at risk for development of maculopathy due to exposure to PPS had received eye examinations, suggesting that those at risk are not receiving adequate screening. We found two patients with PPS maculopathy who had relatively preserved central vision, one patient with bitemporal vision loss, and one patient who developed vision loss in both eyes.

Opioid prescription use in patients with interstitial cystitis.

The opioid epidemic is a recent focus of national initiatives to reduce opioid misuse and related addiction. As interstitial cystitis (IC) is a chronic pain state at risk for narcotic use, we sought to assess opioid prescription use in patients with IC. Data were accessed from the Virginia All Payers Claims Database. We identified female patients diagnosed with IC from 2011 to 2016 using International Classification of Disease codes. A patient identifier was used to link diagnoses with outpatient prescription claims for opioids using generic product identifiers. We then analyzed opioid prescriptions within 30days of a claim with a diagnosis of IC. A total of 6,884 patients with an IC diagnosis were identified. The median number of IC claims per patient was 2 (IQR 1 to 4). Mean patient age was 47.8. Twenty-eight percent of patients received at least 1 opioid prescription, with a median of 2 (IQR 1, 4) per patient. Among those receiving opioids, 185 (9.5%) had more than 10 opioid prescriptions, with a maximum of 129. The most common prescriptions were hydrocodone (n = 2,641, 32.3%), oxycodone (n = 2,545, 31.2%), and tramadol (n = 1,195, 14.6%). There was a decline in opioid prescriptions per month for IC, although the rate per IC diagnosis remained stable. A significant number of patients with IC are treated with opioids. Although the overall number of opioid prescriptions associated with IC had declined, the prescription rate per IC diagnosis had not. As part of the national initiative to reduce opioid use, our data suggest that IC treatment strategies should be examined.

Pentosan Polysulfate Sodium Exposure and Drug-Induced Maculopathy in Commercially Insured Patients in the United States

To determine the association and cumulative dose-response pattern between pentosan polysulfate sodium (PPS) use for interstitial cystitis (IC) and maculopathy. Large, multicenter, retrospective cohort study of commercially insured patients in the MarketScan database (Truven Health Analytics, San Jose, CA). Two hundred twenty-seven thousand three hundred twenty-five patients with IC who were enrolled continuously in the MarketScan database. Cox proportional hazards models (controlling for patient gender, age at index diagnosis of IC, and diagnosis with diabetes mellitus) followed up patients from index diagnosis of IC for 5 years, or until patients discontinued insurance coverage, or until patients' first diagnosis with a maculopathy. As a sensitivity analysis, we re-estimate all models after excluding all patients with diabetes. To assess for dose response, we calculated the total days of PPS prescriptions filled and created a categorical variable indicating total exposure. The primary outcome measure was association between binary PPS exposure and any maculopathy. Secondary outcome measures included exposure between binary and categorical, time-dependent, exposure to PPS and to drusen, nonexudative age-related macular degeneration (AMD), exudative AMD, hereditary maculopathy, and toxic maculopathy. The most common diagnoses of maculopathy in patients with IC were exudative AMD (1.5%), drusen (0.8%), nonexudative AMD (0.3%), toxic maculopathy (0.1%), and hereditary dystrophy (0.04%). In unadjusted analyses, the percentage of patients who filled a PPS prescription and were diagnosed later with a maculopathy (2.37%) was very similar to the percentage of patients who did not fill a prescription (2.77%). Survival models using a binary variable indicating PPS exposure showed no significant associations between PPS exposure and diagnosis of drusen, nonexudative AMD, exudative AMD, toxic maculopathy, hereditary dystrophy, or an aggregate variable of any maculopathy. Similarly, there was no dose-dependent relationship between PPS exposure and diagnosis of any maculopathy. These findings remained stable in sensitivity analysis models that excluded patients with diabetes mellitus. In this large, commercial claims database analysis, no association was found between PPS exposure and subsequent diagnosis of maculopathy.

Introduction of ICICJ 15years.

Introduction of ICICJ 15years.

Pigmentary Maculopathy Associated with Chronic Exposure to Pentosan Polysulfate Sodium

To describe the clinical features of a unique pigmentary maculopathy noted in the setting of chronic exposure to pentosan polysulfate sodium (PPS), a therapy for interstitial cystitis (IC). Retrospective case series. Six adult patients evaluated by a single clinician between May 1, 2015, and October 1,2017. Patients were identified by query of the electronic medical record system. Local records were reviewed, including results of the clinical examination, retinal imaging, and visual function assessment with static perimetry and electroretinography. Molecular testing assessed for known macular dystrophy and mitochondrial cytopathy genotypes. Mean best-corrected visual acuity (BCVA; in logarithm of the minimum angle of resolution units), median cumulative PPS exposure, subjective nature of the associated visual disturbance, qualitative examination and imaging features, and molecular testing results. The median age at presentation was 60 years (range, 37-62 years). All patients received PPS for a diagnosis of IC, with a median cumulative exposure of 2263 g (range, 1314-2774 g), over a median duration of exposure of 186 months (range, 144-240 months). Most patients (4 of 6) reported difficulty reading as the most bothersome symptom. Mean BCVA was 0.1±0.18 logarithm of the minimum angle of resolution. On fundus examination, nearly all eyes showed subtle paracentral hyperpigmentation at the level of the retinal pigment epithelium (RPE) with a surrounding array of vitelliform-like deposits. Four eyes of 2 patients showed paracentral RPE atrophy, and no eyes demonstrated choroidal neovascularization. Multimodal retinal imaging demonstrated abnormality of the RPE generally contained in a well-delineated area in the posterior pole. None of the 4 patients who underwent molecular testing of nuclear DNA returned a pathogenic mutation. Additionally, all 6 patients showed negative results for pathogenic variants in the mitochondrial gene MTTL1. We describe a novel and possibly avoidable maculopathy associated with chronic exposure to PPS. Patients reported symptoms of difficulty reading and prolonged dark adaptation despite generally intact visual acuity and subtle funduscopic findings. Multimodal imaging and functional studies are suggestive of a primary RPE injury. Additional investigation is warranted to explore causality further.

Urine Odor Profiling for Diagnosis of Interstitial Cystitis

Interstitial cystitis (IC) is a clinical condition that manifests as a sensory hypersensitivity of unknown cause and is characterized by frequent urination, bladder discomfort, and pelvic pain. Chronic inflammation is a potential systemic risk factor for IC. However, it remains unknown the underlying mechanism through which a healthy bladder protects itself from inflammatory triggers. In this study, we profiled urinary odor, which consists of various volatile organic chemical compounds in urine obtained from IC patients and healthy controls. Using comprehensive solid phase micro extraction‐gas chromatography‐time‐of‐flight mass spectrometry profiling combined with comprehensive bioinformatics analyses, levels of urinary volatile metabolites in healthy individuals were compared to those in IC patients. Among the several metabolites whose levels were significantly altered, menthol showed significantly reduced levels in IC. In an attempt to understand the mechanistic meaning of IC‐associated volatile metabolite, menthol, we performed cytokine profiling and DNA microarray. Our findings suggest that inflammatory events and the activation of signaling networks were suppressed by menthol treatment. Further validation with biochemical experiments and Western blot analysis confirmed that menthol reduced the expression of cytokines and signaling factors that are closely associated with inflammation. These findings will provide potentially new strategies to alleviating both the odor and inflammation associated with IC.Support or Funding InformationThis work was supported by the National Institutes of Health grants (1U01DK103260, 1R01DK100974, U24 DK097154, NIH NCATS UCLA CTSI UL1TR000124), Department of Defense grants (W81XWH‐15‐1‐0415), Centers for Disease Controls and Prevention (1U01DP006079), IMAGINE NO IC Research Grant, the Steven Spielberg Discovery Fund in Prostate Cancer Research Career Development Award, and the U.S. ‐ Egypt Science and Technology (S&amp;T) Joint Fund, funded by the National Academies of Sciences, Engineering, and Medicine and USAID (all to J.K.). Any opinions, findings, conclusions, or recommendations expressed in this article are those of the authors alone, and do not necessarily reflect the views of any of the previously mentioned sponsors. J.K. is former recipient of Interstitial Cystitis Association Pilot Grant, a Fishbein Family IC Research Grant, New York Academy of Medicine, and Boston Children's Hospital Faculty Development.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Interstitial cystitis: minimal diagnostic criteria

Any article reporting on Interstitial Cystitis (IC) will list numerous investigations. This paper presents a review of the minimum investigations needed and their significance for the initial evaluation and diagnosis of patients with Interstitial Cystitis. To optimize patient?s early diagnosis and disease monitoring, a comprehensive algorithm for the diagnosis of IC has been proposed. The paper defines interstitial cystitis (IC) as a disease of the urinary bladder diagnosed by at least one of the following 3 requirements: 1) endoscopic criteria (cystoscopy findings); 2) pathologic criteria of bladder biopsy; and 3) clinical criteria including pain and lower urinary tract symptoms evaluation. Furthermore, the exclusion of confusable diseases is mandatory in all cases. These are recommendations, mostly based on expert opinions and literature review. Where possible, a level of recommendation was developed according to a 3-grade scale: mandatory (grade 1), recommended (grade 2), and optional (grade 3). By using a stepwise approach and an evidence-based thought process, the diagnosis of IC is made easier and reliable.

Characterizing Health Care Utilization, Direct Costs, and Comorbidities Associated with Interstitial Cystitis: A Retrospective Claims Analysis.

Interstitial cystitis (IC) is a debilitating condition that affects up to 5% of the U.S. This condition is characterized by bladder pain, urinary urgency and frequency, nocturia, and, in some patients, bladder lesions called Hunner's lesions (HL). IC patients who have HL experience a clinical course that is distinct from those without HL and, as a result, respond differently to existing treatments. Without effective and lasting therapeutic options, IC patients are expected to experience a reduced quality of life and be a significant economic burden. Previous research describing the burden of IC is not only outdated but lacks stratification by HL. To (a) characterize health care utilization, direct costs, and comorbidities associated with IC and (b) elucidate differences between patients with and without HL. A retrospective analysis was conducted using health care claims from the Truven Health MarketScan Research Databases. Adults with an incident IC diagnosis between 2009 and 2014 were identified and matched 1:4 to non-IC patients on age, gender, and geographic region. Health care utilization, direct costs, and comorbidities during the first 12 months after diagnosis were compared between the 2 groups, as well as between IC subgroups with and without HL. Associations were evaluated after adjustment for potential confounders using regression models. A total of 24,836 IC patients were identified and matched to 99,344 non-IC patients. Patients were predominantly female (92%), with a mean age of 49.0 (SD = 15.3) years. IC patients used significantly more health care resources across all categories compared with non-IC patients. On average, having IC was associated with $7,223 higher total health care costs than not having IC (95% CI = $6,650-$7,796), with outpatient costs contributing to 71% of the difference, after adjusting for baseline age, gender, region, insurance type, plan type, and Charlson Comorbidity Index (CCI) score. The odds of developing select comorbidities were 2.61 times greater in IC patients compared with non-IC patients (95% CI = 2.52-2.70), adjusting for baseline age, sex, region, and CCI score. Among IC patients, the HL subgroup (n = 292) used more health care resources, and having HL was associated with $6,895 higher total health care costs compared with not having HL (95% CI = $3,770-$10,020) after adjusting for baseline age, gender, region, insurance type, and plan type. Findings suggest that patients with IC have significantly higher health care utilization, costs, and comorbidities compared with non-IC patients. This economic burden is further amplified in those with HL. Funding for this study was contributed by Allergan. Tung was supported by a training grant from Allergan at the time of this study. Hepp was an Allergan employee at the time this study was conducted. The other authors have nothing to disclose. This research was previously presented, in part, as a poster presentation at the International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; Washington, DC; May 23, 2016. Study concept and design were primarily contributed by Hepp, along with Tung and Devine. Tung took the lead in data collection, with assistance from Hepp, and data interpretation was performed by Tung, along with Bansal and Devine. The manuscript was prepared primarily by Tung, along with Devine, Bansal, and Hepp.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.

Management of Bladder Pain Syndrome: Green-top Guideline No. 70.