Pape Janna, Falconi Gabriele, De Mattos Lourenco Thais Regina, Doumouchtsis Stergios K, Betschart Cornelia
Department of Gynecology, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Department of Obstetrics and Gynecology, "San Bortolo" Hospital, Vicenza, Italy.
Int Urogynecol J. 2019 Nov;30(11):1795-1805. doi: 10.1007/s00192-019-03970-5. Epub 2019 May 9.
Interstitial cystitis (IC) and bladder pain syndrome (BPS) are challenging and encompassing hypersensitivity disorders of the lower urinary tract. A variety of national and international guidelines have been published including guidance on nomenclature, definitions, etiopathology, diagnostics and treatment. A lack of universally established clinical guidance is apparent. The aim of this review is to evaluate key guidelines on this area of practice, identify variations, compare their recommendations and grade them using AGREE II.
Literature searches were performed using the PUBMED and CINAHL database from January 1, 1983, to December 1, 2018, referring to the search strategy of AUA. Ten national and international guidelines were included into the analysis. We assessed the guidelines with the updated AGREE II.
Symptoms congruent in all guidelines are: pain, pressure, discomfort and frequency, urgency and nocturia. Urinalysis is a prerequisite for diagnostics, cystoscopy for most and urodynamics not part of the routine assessment. Treatment options are recommended stepwise. The highest level of evidence and consensus was identified for oral therapies. Nine guidelines had an overall quality score ≥ 50% and three scored ≥ 70% (AUA, GG, RCOG).
The guidelines are congruent in symptom reporting, quite congruent in diagnostics and vary to a high degree on treatment recommendations. The complexity of BPS and emerging evidence indicate the need for regular updating of the guidelines and a wider consensus.
间质性膀胱炎（IC）和膀胱疼痛综合征（BPS）是具有挑战性且涵盖下尿路超敏反应的疾病。已经发布了各种国家和国际指南，包括关于命名、定义、病因病理学、诊断和治疗的指导。显然缺乏普遍确立的临床指南。本综述的目的是评估该实践领域的关键指南，识别差异，比较其建议并使用AGREE II对其进行分级。
使用PUBMED和CINAHL数据库，参照美国泌尿外科学会（AUA）的检索策略，从1983年1月1日至2018年12月1日进行文献检索。将十条国家和国际指南纳入分析。我们使用更新后的AGREE II对这些指南进行评估。
所有指南中一致的症状有：疼痛、压迫感、不适以及尿频、尿急和夜尿。尿液分析是诊断的先决条件，大多数情况下需要膀胱镜检查，而尿动力学检查不是常规评估的一部分。推荐逐步进行治疗选择。口服疗法的证据水平和共识程度最高。九条指南的总体质量得分≥50%，三条得分≥70%（AUA、GG、英国皇家妇产科医师学院（RCOG））。
这些指南在症状报告方面是一致的，在诊断方面相当一致，但在治疗建议上差异很大。BPS的复杂性和新出现的证据表明需要定期更新指南并达成更广泛的共识。
