From the Guidelines
The diagnostic consideration for interstitial cystitis in a 44-year-old male should prioritize a comprehensive symptom assessment, physical examination, urinalysis, and exclusion of other conditions, as the disease is often underdiagnosed and may be confused with chronic prostatitis/chronic pelvic pain syndrome. When evaluating a male patient with suspected interstitial cystitis, it is essential to consider the patient's symptoms, such as mild dysuria or urinary urgency, which may progress to severe voiding frequency, nocturia, and suprapubic pain 1. The presence or absence of glomerulations on endoscopy is too nonspecific to make the diagnosis of the disease in anyone who does not fit the symptom complex as defined 1. A logical algorithm for diagnosis and treatment, as presented in the guidelines, can help identify and manage interstitial cystitis/bladder pain syndrome 1. The most recent guideline provides direction to clinicians and patients regarding how to recognize interstitial cystitis/bladder pain syndrome, conduct a valid diagnostic process, and approach treatment with the goals of maximizing symptom control and patient quality of life while minimizing adverse events and patient burden 1. Key considerations in the diagnostic process include:
- Symptom assessment to identify patterns of voiding frequency, nocturia, and suprapubic pain
- Physical examination to evaluate for signs of pelvic floor dysfunction or other underlying conditions
- Urinalysis to rule out other causes of symptoms, such as urinary tract infections or kidney stones
- Exclusion of other conditions, such as chronic prostatitis/chronic pelvic pain syndrome, through a combination of clinical evaluation and diagnostic testing. By prioritizing a comprehensive diagnostic approach, clinicians can improve outcomes for male patients with interstitial cystitis, reducing morbidity, mortality, and enhancing quality of life.
From the FDA Drug Label
All patients met the NIH definition of IC based upon the results of cystoscopy, cytology, and biopsy.
The diagnostic considerations for interstitial cystitis in a 44-year-old male include:
- Cystoscopy: to visualize the bladder and urethra
- Cytology: to examine cells in the urine for abnormal cell growth
- Biopsy: to examine tissue samples from the bladder for signs of interstitial cystitis These diagnostic tests are based on the NIH definition of IC, as mentioned in the clinical trials for pentosan polysulfate 2.
From the Research
Diagnostic Considerations
- The diagnosis of interstitial cystitis is often one of exclusion, and cystoscopy is the best way to confirm the diagnosis 3.
- A thorough medical history, physical examination, and exclusion of other diseases are necessary for diagnosis 4.
- Diagnostic tools such as diaries, cystoscopy with or without hydrodistension, and/or bladder biopsy may be used to aid in diagnosis 4.
Diagnostic Challenges
- Interstitial cystitis is a heterogeneous chronic disease with varying presentations and severities, making diagnosis and treatment challenging 5.
- The condition is often characterized by pelvic pain, frequency, and urgency, but symptoms can be highly variable 5.
Treatment Considerations
- Treatment for interstitial cystitis can be initiated based on symptoms alone, and most patients benefit from an array of different drugs, including pentosan polysulfate, amitriptyline, hydroxyzine, and cimetidine 3.
- Intravesical therapy can be attempted with dimethyl sulfoxide, heparin, or an anesthetic therapeutic combination containing lidocaine if oral drugs are ineffective 3.
- Current American Urological Association (AUA) guidelines separate the IC treatment recommendations into six tiers of increasing invasive therapies, starting with education and lifestyle modifications and progressing through levels of physical, pharmacological, and ultimately surgical therapies 5.