Fall Magnus, Oberpenning Frank, Peeker Ralph
Department of Urology, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
Eur Urol. 2008 Jul;54(1):65-75. doi: 10.1016/j.eururo.2008.03.086. Epub 2008 Apr 3.
Opinions on how to best treat bladder pain/interstitial cystitis are ambiguous.
To review previous and recent literature on this subject to assess the current state of evidence.
With important previous papers reviewed for the 2003 European Association of Urology guidelines as background, the PubMed database was searched and articles published in 2003-2007 were reviewed and relevant ones were selected for detailed study.
A large number of studies describing a variety of quite dissimilar therapeutic principles were retrieved. The various methods and level of evidence are summarised in tables. Only pentosan polysulfate sodium (oral and intravesical), amitriptyline, hydroxyzine, cyclosporin A, intravesical dimethyl sulfoxide, transurethral resection of visible Hunner lesions, and major reconstructive surgery reached a high degree of recommendation. However, a number of pitfalls hamper evaluation of the available information; a crucial one is that our understanding of basic mechanisms causing bladder pain is fragmentary. So far, we are faced with a large variety of hypotheses although it is difficult to identify the most relevant ones. In this respect, we are not much helped by the recent literature because many studies have poor descriptions of patients or are of a pilot character, with no follow-up by larger trials. Controlled studies are rather scarce. On the other hand, some good-quality studies following up positive pilot trials end up with negative results.
Perhaps the most significant problem concerns inclusion and exclusion criteria in bladder pain syndrome/interstitial cystitis studies. At this stage, it is not too easy to communicate the wide available expert knowledge to the general audience. More sophisticated standards, capable of being generally used, have to come.
关于如何最佳治疗膀胱疼痛/间质性膀胱炎的观点尚不明确。
回顾此前及近期关于该主题的文献，以评估当前的证据状况。
以2003年欧洲泌尿外科学会指南所回顾的重要既往论文为背景，检索了PubMed数据库，并对2003年至2007年发表的文章进行了回顾，挑选出相关文章进行详细研究。
检索到大量描述各种截然不同治疗原则的研究。各种方法及证据水平在表格中进行了总结。仅多硫酸戊聚糖钠（口服及膀胱内灌注）、阿米替林、羟嗪、环孢素A、膀胱内灌注二甲亚砜、经尿道切除可见的Hunner病变以及大型重建手术获得了高度推荐。然而，诸多缺陷妨碍了对现有信息的评估；关键的一点在于，我们对导致膀胱疼痛的基本机制的理解尚不完整。到目前为止，尽管难以确定最相关的假设，但我们面临着各种各样的假设。在这方面，近期的文献对我们帮助不大，因为许多研究对患者的描述欠佳或属于试验性研究，且没有大型试验的后续跟进。对照研究相当稀少。另一方面，一些对阳性试验性研究进行跟进的高质量研究最终却得出了阴性结果。
或许最显著的问题涉及膀胱疼痛综合征/间质性膀胱炎研究中的纳入和排除标准。在现阶段，要将广泛的专业知识传达给普通大众并非易事。必须要有更完善的、能够普遍应用的标准。
