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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 A prosztatitis játékok 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 in the publication of this paper. J Urol ; —6. Interstitial cystitis: an introduction to the problem. In: Interstitial cystitis. Lon- don: Springer-Verlag, The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database study.
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March 28—30, Kyoto, Japan. Int J Urol ; 10 Suppl i—iv :S1— Criteria for rheumatic disease. Different types and different functions. Arthritis Rheum ;— Primary evaluation of patients suspected of having interstitial cystitis IC.
Eur Urol ;—9. EAU guidelines on chronic pelvic pain. Toward optimal health: Philip Hanno, M. Interview by Jodi R. J Womens Health Larchmt ;—8. Urgency: the key to defining the overactive bladder. BJU Int ;96 Suppl 1 :1—3. Correlation between 2 interstitial cystitis symptom instruments. Classification of chronic pain, descriptions of chronic pain syndromes and definitions of pain terms. IASP Press; Updated results of a randomized, double-blind, multicenter sham-controlled trial of microwave thermotherapy with the Dornier Urowave in patients with symptomatic benign prostatic hyperplasia.
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In: Campbell-Walsh Urology e-dition, ed. Elsevier, Mosby, Saunders; Chronic pelvic pain as a form of complex regional pain syndrome. Clin Obstet Gynecol ;— Report and abstracts. BPS may occur together with confusable diseases such as chronic or remitting urinary infections or nonbacterial prostatitis treatment guidelines 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 nonbacterial prostatitis treatment guidelines 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.
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 nonbacterial prostatitis treatment guidelines, in therapeutic, personal, social, and many other aspects.
IC, originally considered a bladder disease, is now considered a chronic pain syndrome . 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 been 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 pelvic 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, nonbacterial prostatitis treatment guidelines, 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 and discomfort in the bladder region [13—15].
The sensation is therefore by definition a pain sensation, but not described as Kezelési módszer prosztatitis 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 nonbacterial prostatitis treatment guidelines consider urgency to mean a need to void as a way of avoiding intensifying pain, pressure, or discomfort.
Urinary urgency was left nonbacterial prostatitis treatment guidelines of the description of patients who need further evaluation for the presence of BPS for several reasons.
Second, the clinical aspects 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 of 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.
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It must be stressed that the presence of these symptoms is not nonbacterial prostatitis treatment guidelines to suspect or diagnose BPS. Why should confusable diseases be excluded? In evidence-based medicine, nonbacterial prostatitis treatment guidelines 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 nonbacterial prostatitis treatment guidelines 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.