Clearer definition of painful bladder syndrome

The results of the latest meeting of ESSIC in Baden, Germany have been published, and provide a very well thought-out and organized conception of painful bladder syndrome, interstitial cystitis, the components of its diagnosis, and definitions of other disorders that can result in confusion in diagnosis.

Joop van de Merwe and Jorgen Nordling have put together a cogent, concise summary of the meeting which details European views and will be influential around the world.

Much of the basis of the definitions comes from the International Continence Society body of work, but with some clarifications and modifications. Painful bladder syndrome is defined as the "complaint of suprapubic pain related to bladder filling, accompanied by other symptoms, such as increased daytime and night-time frequency, in the absence of proven urinary infection or other obvious pathology. Interstitial cystitis is PBS with typical cystoscopic and/or histological features in the absence of infection or other pathology."

The group addressed the potassium sensitivity test and concluded that it lacks properties to allow its use as an aid for the diagnosis of PBS/IC, and that no efforts should be undertaken to evaluate its possible value for the diagnosis of PBS/IC in connection with future data collection for the development of diagnostic criteria.

A consequence of the European definition, which tries to split out IC from PBS, is that cystoscopy is an essential part of the diagnostic algorithm and biopsy is optional. This relates to how IC is defined in this context by these investigators.

This report is "must reading" for those interested in furthering knowledge about this group of disorders, whether by clinical trials or basic research. Input from North American and Asian investigators in the future, perhaps with the help of the National Institutes of Health, Center for Disease Control, and/or the Food and Drug Administration will ultimately help to solidify and codify this process, which will prove to be of benefit for pharmaceutical companies and patients in the long run.

By Philip M. Hanno, MD, MPH