膀胱疼痛症候群/間質性膀胱炎

Bladder Pain Syndrome International Consultation on Incontinence

 

1.研究目的：

       ICS的Bladder Pain Syndrome的國際諮詢委員會被賦予重新review膀胱疼痛症候群(Bladder Pain Syndrome)，以前被稱為間質性膀胱炎(Interstitial Cystitis)，用更詳細的方法來回顧此症候群。這篇文章包括下列標題：定義、命名、分類、流行病學、病因學、病理、診斷、症狀量表、結果評價，處理原則、特殊的治療和未來的研究方向。

 

2.研究設計、材料及方法：

       主要是強調自4年前的會議至今的最新發展，而Evidence與recommend dation都是根據oxford systom的分類。

       方法由Pubmed datnbase搜尋”Interstitial Cystitis”、” Painful Bladder Syndrome”、” Bladder Pain Syndrome(BPS)”或 ”Chronic Interstitial Cystitis”。自2004年1月至2008年5月，512篇paper被發表，主要針對clinicul trial、RCT、meta-analysis、scitific guidelie和core clinical journals。而Evidence的分級level和grade of recommen dation是根據Oxford Scale。

 

3.結果：

(1)定義與命名：

ICS的國際科學諮詢委員會(scientific committee of the Internatial Consultation)投票決定使用Bladder pain syndrome來取代Interstitial cystitis。因為IC interstitial cystitis 指的是膀胱壁的發炎，並不能精確的描述這群病人的症狀。所以ICS 於2002年之後term改用painful bladder syndrome,指當膀胱漲尿時，會有suprapubic pain。但是painful bladder syndrome 對這群病人仍太過嚴格，(2006Warren et al. 發現只有66%的PBS/interstitial cystitis的病人適用於ICS的定義)。所以決定採用bladder pain syndrome ( BPS)命名較合適。

Bladder pain syndrome 是一種臨床診斷。定義為chronic pelvic pain (> 6 months), pressure or discomfort的感覺和膀胱有關同時必須伴隨一種其他的解尿症狀如急尿或頻尿。

 

4. 處理原則

(1)初步病史評估：如果病人有膀胱位置的疼痛、壓痛及不舒服而且有下泌尿道症狀大於6週同時沒有UTI及其他病因，則可以做BPS的初步評估，包括frequency/volume chart、PE U/A和urine culture。如果臨床需要Cytology和膀胱竟可以考慮做。

(2)初步治療：教育病人了解疾病、飲食治療、非處方的止痛藥、骨盆放鬆…等這些都是BPS的初步治療。若無效，則使用口服藥、物理治療、及膀胱內灌注。

(3)再次評估：假如口服或膀胱內灌注無效或者是在做上述治療之前，可以再更進一步評估，包括UDS、骨盆影像、麻醉下的膀胱鏡水擴張併膀胱切片、腹腔鏡檢查。

(4)頑固性的PBS/IC：

可以做neuromodulation、intravesical Botulinum toxin，最後才用Augmentation cystoplasty和urinary diversion。

 

由以上的處理原則發現和台灣的診斷及處理稍微有些不同。

 

Bladder Pain Syndrome International Consultation on Incontinence

 

abstract

Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature, taxonomy, epidemiology, etiology,pathology, diagnosis, symptom scales, outcome assessment, principles of management, specific therapies, and future directions in research. Study Design, Materials, Methods: The emphasis was on new information developed

since the last consultation 4 years previously. Where possible, existing evidence was assessed and a level of recommendation was developed according to the Oxford system of classification. Results: The consultation decided to refer to the condition as ‘‘bladder pain syndrome’’ (BPS) because the designation is more descriptive of the clinical condition and better fits standard classification taxonomy. Reasonable definitions of BPS include the definition of the ESSIC European group and a slight modification made at a SUFU sponsored Miami meeting in early 2008. Males or females with pain, pressure, or discomfort that they perceive to be related to the bladder with at least one urinary symptom, such as frequency not obviously related to high fluid intake, or a persistent urge to void should be evaluated for possible BPS. The initial assessment consists of a frequency/volume chart, focused physical examination, urinalysis, and urine culture. Urine cytology and cystoscopy are recommended if clinically indicated. Treatment progresses from conservative management through various oral and intravesical therapies, with most surgical therapies reserved for unresponsive cases. Pain management is critical throughout the treatment process. The consultation believes that the disorder is best viewed as one of a group of chronic pain syndromes, rather than as primarily an inflammatory bladder disorder. Recommendations for future research pathways are suggested. Neurourol. Urodynam. 29:191–198, 2010.