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Treatment of Bladder Pain Syndrome/Interstitial Cystitis 2008: Can We Make Evidence-Based Decisions?

Artikel i vetenskaplig tidskrift
Författare Magnus Fall
F Oberpenning
Ralph Peeker
Publicerad i European Urology
Volym 54
Nummer/häfte 1
Sidor 65-75
ISSN 0302-2838
Publiceringsår 2008
Publicerad vid Institutionen för kliniska vetenskaper
Sidor 65-75
Språk en
Länkar dx.doi.org/10.1016/j.eururo.2008.03...
Ämnesord Bladder pain syndrome; Interstitial cystitis; Evidence level
Ämneskategorier Urologi och andrologi

Sammanfattning

Abstract Context Opinions on how to best treat bladder pain/interstitial cystitis are ambiguous. Objective To review previous and recent literature on this subject to assess the current state of evidence. Evidence acquisition 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. Evidence synthesis 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. Conclusion 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. Take Home Message Evaluation of the rich literature on bladder pain syndrome/interstitial cystitis is difficult. The most significant problem concerns inclusion and exclusion criteria. It is not easy to communicate available expert knowledge, and more sophisticated standards, capable of being generally used, must come.

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