Use permanent link to share in social media Share with a friend Please login to send this document by email! A new classification is needed for pelvic pain syndromes—are existing terminologies of spurious diagnostic authority bad for patients? J Urol ; — Annu Rev Med ; — This will allow the evaluation of individual symptoms that warrant further evaluation for the presence of BPS and the relative contribution of the applied diagnostic procedures, including cystoscopy with hydrodistention and biopsy findings, to distinguish patients with BPS from those without BPS but one of the confusable diseases.
Conflicts of interest None of the authors has conflicts of interest bph vs prostate cancer physical exam the publication of this paper.
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Urol Int ;— Urology ;— Urology ; —42, discussion —3. Overactive bladder and painful bladder syndrome: there need not be confusion. Neurourol Urodyn ;— The urgency perception score: validation and test- retest. J Urol ;— Urology ;—4. The role of urinary potassium in the pathogenesis and diagnosis of interstitial cystitis. J Urol ;—6, discussion —7.
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Male and female subjects at least 18 years of age 2. Able to provide informed consent 3.
Clin Obstet Gynecol ;— Report and abstracts. BPS may occur together with confusable diseases such as chronic or remitting urinary infections or endo- metriosis. Cystoscopy with hydrodistention and biopsies might in this situation document positive signs of BPS thereby making a double diagnosis more probable.
For therapeutic studies it makes sense to exclude patients who also have a con- fusable disease because symptoms and signs may be caused by BPS, the confusable disease, or by both. For prevalence studies of BPS, on the other hand, all cases with BPS should be included, also those with a confusable disease. This approach eliminates the need for separate diagnostic criteria for clinical practice and scientific studies.
Why do we need various BPS types? Unravelling the cause of a disease usually begins with grouping patients with similar symptoms and signs. The hypothesis is that these patients have a disease with the same etiopathogenesis that is better recognized in homogeneous than in heterogeneous groups.
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This has been the reason for dividing BPS patients into subgroups types based on positive signs. It is worth noting that the Hunner type of disease stands out as a specific type, not only cysto- scopically but also with reference to histopathology, response to treatment, and complications [8,23].
Why do we propose to change the name of IC? Hanno recently stated that the term IC was not descriptive of the clinical syndrome or the pathologic findings in many cases. Moreover, the term IC is misleading because it directs attention only to the urinary bladder and inflammation .
The name IC excludes patients with typical IC symptoms but normal cystoscopic and histologic findings from disease classification in many countries around the world.
The inability to classify these patients might have severe negative consequences for the patients, for example, in therapeutic, personal, social, and many other aspects. IC, originally considered a bladder disease, is now considered a chronic pain syndrome térdízület komplex kezelése. These perceptions have led to the current effort to reconsider the name of the disorder [8,24,26,27].
Why do we propose to choose BPS as the new name?
For some time now there has bph vs prostate cancer physical exam much work going on in international organizations to create a logical and workable terminology for chronic persistent pain conditions. This implies a taxonomy-like approach under the umbrella term of chronic pelvic pain syndrome. Further identification is based on the primary organ that appears to be affected on clinical grounds.
Urologic pelvic pain syndromes are divided into bladder pain syndrome, urethral pain syndrome, penile pain syndrome, prostate pain syndrome, and others.
More specific terminology is based on the identification of, for example, inflammation or infection [27,28]. The classification system of chronic pelvic pain syndromes aims to draw together the expertise of many specialist groups. The impact of the classification of chronic pelvic pain syndromes thus goes far beyond the scope of IC. Another essential feature is that the nomenclature and knowledge of pathophysiologic mechanisms do not conflict with each other.
In this context, the name bladder pain syndrome was considered the best new name for IC to date, because the name is in line with the other chronic bph vs prostate cancer physical exam pain syndromes and is in balance with the clinical presentation of the syn- drome and the level of knowledge of its pathophy- siology. We realize that changing the name of IC into BPS may have emotional implications, understandably for patients, but also for patient organizations with a scope limited to IC and for insurance and reimbursement in different health systems around the world.
In this context, it is worth remembering that a subgroup of BPS patients representing the Hunner type of disease presents interstitial inflammation and is thus fulfilling the requirements of the original term of IC.
Next steps A worldwide evidence-based consensus is lacking on whether chronic pelvic pain perceived to be related to the bladder is a prerequisite for a diagnosis of BPS and on the value of cystoscopy with hydrodistention and biopsies for the manage- ment of patients with BPS. For this reason, ESSIC will start a prospective validation study in which europeanurology53 60—67 65 5. Why is pain a prerequisite?
BPS is characterized by urinary bladder pain [9,10]. A recent study, however, demonstrated a correlation between pain bother in the IC problem index burning, discomfort, pain, or pressure and the presence of pain in the IC symptom index of only 0.
The International Association for the Study of Pain; www. Patients having microwave treatment for benign prostatic obstruction producing tissue damage at the bladder neck report the same sensation of pressure bph vs prostate cancer physical exam discomfort in the bladder region [13—15].
The sensation is therefore by definition a pain sensation, but not described as such by the patient. Pain or the equivalent pressure, discomfort perceived to be related to the bladder was, therefore, considered to be a prerequisite for the description of symptoms on the basis of which patients should undergo further investigations for BPS. The increase of pain on bladder filling was left out of the description because this association is not always present [9,16,17].
Why is urgency not included in the description of patients who need further evaluation for BPS? Urgency is defined by the ICS as the complaint of a sudden compelling desire to pass urine, which is difficult to defer . For some women, urgency is used to indicate the heightened need to make it to a toilet quickly to avoid getting wet, whereas other women consider urgency to mean a need to void as a way of avoiding intensifying pain, pressure, or discomfort.
Urinary bph vs prostate cancer physical exam was left out of the description of patients who need further evaluation for the presence of BPS for several reasons. Second, the clinical bph vs prostate cancer physical exam of urgency are complex [4,9,17—21]. At a meeting arranged by the Association of Reproductive Health Professionals www. Hanno, Many patients find the strong, discomfortable urge to void the most dominant and disabling part fájdalomcsillapító gyógyszerek a nagy lábujjak ízületei their symptomatology, so patients and doctors are often confused because, with the present terminology, a patient is not allowed to use the word urge to describe complaints.
So the words urgency and urge describe very well the difference between the sensation felt by the patient with OAB and the patient with BPS. Persistent urge was therefore included in the definition as a typical symptom, such as frequency. It must be stressed that the presence of these symptoms is not necessary to suspect or diagnose BPS. Why should confusable diseases be excluded? In evidence-based medicine, diagnoses are based on medical history, physical examination, and appro- priate clinical investigations to eliminate diseases from the list of differential diagnoses confusable Fig.
Classification of BPS Consensus was obtained that for the documentation of positive signs for the diagnosis of BPS, hydro- distention at cystoscopy was a prerequisite and if indicated a biopsy to document histologic details of BPS. The following definition by Fall was accepted. This site ruptures with increasing bladder distension, with petechial oozing of blood from the lesion and the mucosal margins in a waterfall manner.
A rather typical, slightly bullous edema develops post-dis- tension with varying peripheral extension. Types of BPS BPS shows large variations among patients in clinical presentation, complaints, quality of life, cystoscopic and biopsy findings, response to treatment, clinical course, and prognosis. It was generally appreciated that these characteristics may be correlated only to some extent.
Diagnostic criteria and disease classification should facilitate future studies on these relationships. The name BPS will be bph vs prostate cancer physical exam by a type indication that consists of two symbols: symbols 1, 2, or 3 indicate findings at cystoscopy with hydrodistention and symbols A, B or C of biopsy findings.
X indicates that no cystoscopy with hydrodistention first symbol or no biopsy second symbol was done Table 2. BPS types thus also allow classification of patients with normal findings at cystoscopy fáj a jobb láb ízületei hydrodistention and normal biopsies as long as they fulfill the patient selection criteria and confusable diseases are excluded BPS type 1A; Fig.
Why do we need new criteria? These criteria, however, do not recognize more than one third of patients considered to have IC by experts . These considerations make the NIDDK criteria less useful in clinical situations and limit their value in scientific studies because the criteria only recognize a biased minority of the patient population.
The need for the design of new diagnostic criteria is obvious. To avoid unacceptable discrepancies between scientific studies and clinical practice, it was considered essential that new diagnostic criteria could be used in both situations. These criteria were meant for scientific studies.
They have worked well in a scientific setting, but were fulfilled by only one third of patients thought to have IC by experts . Logically IC should include some form of inflammation in the deeper layers of the bladder wall, whereas PBS should include pain in the region of the bladder.
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At the International Consultation on Interstitial Cystitis in Japan ICICJ in bph vs prostate cancer physical exam, it became clear that the evaluation and diagnosis of patients differed enormously among centers in Europe, North America, and Japan  and that a new approach was urgently needed. Criteria for a diagnosis are needed only if the target disease may be confused with other diseases confusable diseases bph vs prostate cancer physical exam of overlapping fea- tures .
For a diagnosis, the target disease has to be recognized in a pool of confusable diseases in one of two ways: by recognition of the specific combination of features of the target disease or by exclusion of confusable diseases.
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