Fig. 11.1
Schematic representation of the proposed steps in the diagnosis of bladder pain syndrome (BPS) including patient selection, exclusion of confusable diseases and classification of BPS
11.3.2.1 Selection of Patients
It was agreed that further investigations for BPS should be done for patients with chronic (>6 months) 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 increased frequency.
11.3.2.2 Confusable Disease: Diagnosis or Exclusion
Confusable diseases as the cause of the symptoms must be excluded. Table 11.1 shows the diseases that were discussed and accepted as confusable diseases for BPS with an indication as to how they can be recognized or excluded. However, a diagnosis of a confusable disease does not necessarily exclude a diagnosis of BPS. This is relevant for patients in whom treatment of the confusable disease does not resolve their urinary symptoms.
Table 11.1
Confusable diseases for bladder pain syndrome (BPS)
Confusable disease | Excluded or diagnosed bya |
|---|---|
Carcinoma and carcinoma in situ | Cystoscopy and biopsy |
Infection with | |
Common intestinal bacteria | Routine bacterial culture |
Chlamydia trachomatis, Ureaplasma urealyticum, | Special cultures |
Mycoplasma hominis, Mycoplasma genitalium, | |
Corynebacterium urealyticum, Candida species | |
Mycobacterium tuberculosis | Dipstick; if “sterile” pyuria culture for M. tuberculosis |
Herpes simplex and Human Papilloma Virus | Physical examination |
Radiation | Medical history |
Chemotherapy, including immunotherapy with cyclophosphamide | Medical history |
Anti-inflammatory therapy with tiaprofenic acid | Medical history |
Bladder neck obstruction and neurogenic outlet obstruction | Uroflowmetry and ultrasound |
Bladder stone | Imaging or cystoscopy |
Lower ureteric stone | Medical history and/or haematuria: upper urinary tract imaging such CT or IVP |
Urethral diverticulum | Medical history and physical examination |
Urogenital prolapse | Medical history and physical examination |
Endometriosis | Medical history and physical examination |
Vaginal candidiasis | Medical history and physical examination |
Cervical, uterine and ovarian cancer | Physical examination |
Incomplete bladder emptying (retention) | Post-void residual urine volume measured by ultrasound scanning |
Overactive bladder | Medical history and urodynamics |
Prostate cancer | Physical examination and PSA |
Benign prostatic obstruction | Uroflowmetry and pressure-flow studies |
Chronic bacterial prostatitis | Medical history, physical examination, culture |
Chronic non-bacterial prostatitis | Medical history, physical examination, culture |
Pudendal nerve entrapment | Medical history, physical examination, nerve block may prove diagnosis
Related posts: Historical Perspectives
The Epidemiology of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS): How Good Was a Study of 30-Years Ago
Intravesical Therapy and Its Evolution Over Three Decades, A European View
Use of Transcutaneous Electrical Nerve Stimulation in the Management of Bladder Pain Syndrome: 2017 Update
The Use of Pentosan Polysulfate in the Management of Interstitial Cystitis
 Differences in Clinical Features and Histopathology in BPS/IC with and without Hunner Lesions
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