ESSIC 2008 Annual Meeting ‐ Rome Interstitial Cystitis: Diagnosis and Definition ESSIC approach pp A painful, painful potentially disabling, disabling inflammatory disease of the urinary bladder of unknown etiology. Jørgen Nordling, chairman ESSIC Professor of Urology University of Copenhagen Denmark NIDDK Criteria  NIDDK Criteria Exclusions     Both   Bladder pain or urinary urgency; glomerulations or Hunner’s ulcer          Cystometric awake capacity > 350 ml. Using fill rate 3030-100ml/min, absence of intense urge to void at 100 ml gas or 150 ml liquid. IVC on cystometry Awake frequency < 8/day No nocturia i Duration < 9 mdr. Age < 18 years Cystitis (bakterial, chemical, TB, XRT) Prostatitis, Vaginitis Bladder, uterine, cervix, vaginal, urethral cancer Activ herpes Bladder or lower ureteral calculi Urethral diverticulum Wein A et al.in Hanno et al.: Interstitial Cystitis.SpringerCystitis.Springer-Verlag, 1990 33-15 ICS definition Results:  The subcommittee found that in the 15 years since publication of the original NIDDK guidelines there h has h bbeen no high hi h quality li evidence to support the routine use of any diagnostic test in defining IC.  Painful Bladder syndrome (PBS) defined by ICS “suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and nighttime frequency in the absence of infection or other pathology”. IC: above with “typical cystoscopic and histological features” Abrams et al. Neurourol Urodyn 2002;21:167--78 2002;21:167 Diagnosis and Definition: ESSIC Approach ‐ J. Nordling 1 ESSIC 2008 Annual Meeting ‐ Rome COPENHAGEN WORKSHOP ON IC May 22-24 2003 June 2004 Copenhagen  ESSIC 2005 Baden Austria The European Society for the study of Interstitiel Cystitis / Painful Bladder syndrome (ESSIC) was founded. www.essic.eu ICS definition   Painful Bladder syndrome (PBS) defined by ICS “suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and nighttime frequency in the absence of infection or other pathology”. IC: above with “typical cystoscopic and histological features” Abrams et al. Neurourol Urodyn 2002;21:167--78 2002;21:167 Diagnosis and Definition: ESSIC Approach ‐ J. Nordling PBS/IC and confusable diseases carcinoma carcinoma in situ infection with intestinal bacteria infection with Mycobacterium tuberculosis Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Mycoplasma genitalis Corynebacterium urealyticum Candida species Herpes simplex Human Papilloma Virus radiation cystitis chemotherapy-induced cystitis cyclophosphamide-induced cystitis tiaprofenic acid-induced cystitis bladder neck obstruction neurogenic outlet obstruction bladder stone lower ureteric stone  upper UT imaging urethral diverticulum endometriosis vaginal candidiasis cervical uterine and ovarian cancer cervical, incomplete bladder emptying (retention) prostate cancer  PSA benign prostatic obstruction chronic bacterial prostatitis  culture chronic non-bacterial prostatitis pudendal nerve entrapment nerve block pelvic floor muscle related pain PBS/IC ESSIC consensus 2005-2006 2 ESSIC 2008 Annual Meeting ‐ Rome medical history eliminates carcinoma carcinoma in situ infection with intestinal bacteria infection with Mycobacterium tuberculosis Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Mycoplasma genitalis Corynebacterium urealyticum Candida species Herpes simplex Human Papilloma Virus radiation cystitis chemotherapy-induced cystitis cyclophosphamide-induced cystitis tiaprofenic acid-induced cystitis bladder neck obstruction neurogenic outlet obstruction bladder stone lower ureteric stone  upper UT imaging urethral diverticulum endometriosis vaginal candidiasis cervical uterine and ovarian cancer cervical, incomplete bladder emptying (retention) prostate cancer  PSA benign prostatic obstruction chronic bacterial prostatitis  culture chronic non-bacterial prostatitis pudendal nerve entrapment nerve block pelvic floor muscle related pain PBS/IC physical examination eliminates carcinoma carcinoma in situ infection with intestinal bacteria infection with Mycobacterium tuberculosis Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Mycoplasma genitalis Corynebacterium urealyticum Candida species Herpes simplex Human Papilloma Virus radiation cystitis chemotherapy-induced cystitis cyclophosphamide-induced cystitis tiaprofenic acid-induced cystitis bladder neck obstruction neurogenic outlet obstruction bladder stone lower ureteric stone  upper UT imaging urethral diverticulum endometriosis vaginal candidiasis cervical uterine and ovarian cancer cervical, incomplete bladder emptying (retention) prostate cancer  PSA benign prostatic obstruction chronic bacterial prostatitis  culture chronic non-bacterial prostatitis pudendal nerve entrapment nerve block pelvic floor muscle related pain PBS/IC ESSIC consensus 2005-2006 ESSIC consensus 2005-2006 dipstick analysis and cultures eliminate carcinoma bladder neck obstruction flowmetry, pressurepressure-flow and ultrasound eliminate carcinoma bladder neck obstruction carcinoma in situ infection with intestinal bacteria infection with Mycobacterium tuberculosis Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Mycoplasma genitalis Corynebacterium urealyticum Candida species Herpes simplex Human Papilloma Virus radiation cystitis chemotherapy-induced cystitis cyclophosphamide-induced cystitis tiaprofenic acid-induced cystitis carcinoma in situ infection with intestinal bacteria infection with Mycobacterium tuberculosis Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Mycoplasma genitalis Corynebacterium urealyticum Candida species Herpes simplex Human Papilloma Virus radiation cystitis chemotherapy-induced cystitis cyclophosphamide-induced cystitis tiaprofenic acid-induced cystitis neurogenic outlet obstruction bladder stone lower ureteric stone  upper UT imaging urethral diverticulum endometriosis vaginal candidiasis cervical uterine and ovarian cancer cervical, incomplete bladder emptying (retention) prostate cancer  PSA benign prostatic obstruction chronic bacterial prostatitis  culture chronic non-bacterial prostatitis pudendal nerve entrapment nerve block pelvic floor muscle related pain PBS/IC neurogenic outlet obstruction bladder stone lower ureteric stone  upper UT imaging urethral diverticulum endometriosis vaginal candidiasis cervical uterine and ovarian cancer cervical, incomplete bladder emptying (retention) prostate cancer  PSA benign prostatic obstruction chronic bacterial prostatitis  culture chronic non-bacterial prostatitis pudendal nerve entrapment nerve block pelvic floor muscle related pain PBS/IC ESSIC consensus 2005-2006 cystoscopy and biopsy if indicated eliminate carcinoma bladder neck obstruction carcinoma in situ infection with intestinal bacteria infection with Mycobacterium tuberculosis Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Mycoplasma genitalis Corynebacterium urealyticum Candida species Herpes simplex Human Papilloma Virus radiation cystitis chemotherapy-induced cystitis cyclophosphamide-induced cystitis tiaprofenic acid-induced cystitis neurogenic outlet obstruction bladder stone lower ureteric stone  upper UT imaging urethral diverticulum endometriosis vaginal candidiasis cervical uterine and ovarian cancer cervical, incomplete bladder emptying (retention) prostate cancer  PSA benign prostatic obstruction chronic bacterial prostatitis  culture chronic non-bacterial prostatitis pudendal nerve entrapment nerve block pelvic floor muscle related pain PBS/IC ESSIC consensus 2005-2006 Diagnosis and Definition: ESSIC Approach ‐ J. Nordling ESSIC consensus 2005-2006 Leaving carcinoma carcinoma in situ infection with intestinal bacteria infection with Mycobacterium tuberculosis Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma hominis Mycoplasma genitalis Corynebacterium urealyticum Candida species Herpes simplex Human Papilloma Virus radiation cystitis chemotherapy-induced cystitis cyclophosphamide-induced cystitis tiaprofenic acid-induced cystitis bladder neck obstruction neurogenic outlet obstruction bladder stone lower ureteric stone  upper UT imaging urethral diverticulum endometriosis vaginal candidiasis cervical uterine and ovarian cancer cervical, incomplete bladder emptying (retention) prostate cancer  PSA benign prostatic obstruction chronic bacterial prostatitis  culture chronic non-bacterial prostatitis pudendal nerve entrapment nerve block pelvic floor muscle related pain PBS/IC ESSIC consensus 2005-2006 3 ESSIC 2008 Annual Meeting ‐ Rome Cystoscopy and morphology  Because it is widely felt, that cystoscopy and bladder morphology provides important information, it was decided to make a classification including findings like glomerulations and Hunner’s lesion during cystoscopy with hydrodistension and inflammatory or other changes at morphological investigation of bladder biopsies. ICS definition   Painful Bladder syndrome (PBS) defined by ICS “suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and nighttime frequency in the absence of infection or other pathology”. IC: above with “typical cystoscopic and histological features” Abrams et al. Neurourol Urodyn 2002;21:167--78 2002;21:167 CONSENSUS ON PBS/IC NOMENCLATURE ESSIC MEETING LONDON 2006 CONSENSUS ON PBS/IC NOMENCLATURE ESSIC MEETING LONDON 2006 that the diagnosis g will be made on the basis of the symptom of pain related to the urinary bladder, accompanied by at least one other urinary symptom such as day-time and nighttime frequency, exclusion of confusable diseases as the cause of the symptoms and cystoscopy with hydrodistension and biopsy if indicated* that the diagnosis g will be made on the basis of the symptom of pain, pressure, discomfort related to the urinary bladder, accompanied by at least one other urinary symptom such as daytime and night-time frequency, exclusion of confusable diseases as the cause of the symptoms and cystoscopy with hydrodistension and biopsy if indicated* Diagnosis and Definition: ESSIC Approach ‐ J. Nordling 4 ESSIC 2008 Annual Meeting ‐ Rome ICS definition   Painful Bladder syndrome (PBS) defined by ICS “suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and nighttime frequency in the absence of infection or other pathology”. IC: above with “typical cystoscopic and histological features” CONSENSUS ON PBS/IC NOMENCLATURE ESSIC MEETING LONDON 2006 that the diagnosis will be made on the basis of the symptom of pain related to the urinary bladder, bladder accompanied by at least one other urinary symptom such as day-time and night-time frequency, exclusion of confusable diseases as the cause of the symptoms and cystoscopy with hydrodistension and biopsy if indicated* Abrams et al. Neurourol Urodyn 2002;21:167--78 2002;21:167 ICS definition   Painful Bladder syndrome (PBS) defined by ICS “suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and nighttime frequency in the absence of infection or other pathology”. IC: above with “typical cystoscopic and histological features” Abrams et al. Neurourol Urodyn 2002;21:167--78 2002;21:167 CONSENSUS ON PBS/IC NOMENCLATURE ESSIC MEETING LONDON 2006 that the diagnosis will be made on the basis of the symptom of pain related to the urinary bladder, bladder accompanied by at least one other urinary symptom such as day-time and night-time frequency, exclusion of confusable diseases as the cause of the symptoms and cystoscopy with hydrodistension and biopsy if indicated* *If indicated to document the type of BPS. Taxonomy  Painful Bladder Syndrome does not fit into the taxonomy of other pelvic pain syndromes like:    Urethral pain syndrome Vulvar pain syndrome Etc. Diagnosis and Definition: ESSIC Approach ‐ J. Nordling Taxonomy  Painful Bladder Syndrome does not fit into the taxonomy of other pelvic pain syndromes like:     Urethral pain syndrome Vulvar pain syndrome Etc. Interstitial Cystitis (IC) is a word so loaded with different interpretations, that it should be avoided . 5 ESSIC 2008 Annual Meeting ‐ Rome Taxonomy ESSIC definition 2008   It was therefore decided to use the name Bladder Pain Syndrome in the future   Bladder Pain Syndrome (BPS) is diagnosed on the basis of chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or frequency. frequency Confusable diseases as the cause of the symptoms must be excluded. The presence of other organ symptoms as well as cognitive, behavioral, emotional, and sexual symptoms should be addressed van de Merwe J. et al. European Urology 2008, 53:6053:60-67.  Thank You! 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