UroToday - The long anticipated Japanese guideline for the diagnosis and treatment of interstitial cystitis endorsed by the Japanese Urological Association has now been published. Homma and colleagues from Tokyo and throughout Japan have written a concise guideline backed by 220 references. The guideline may well form the basis for an Asian guideline now under consideration, and will no doubt be highly influential in Asia and around the world.

For the guideline, IC is defined as "a disease of the urinary bladder diagnosed by three conditions:

1)lower urinary tract symptoms such as urinary frequency, bladder hypersensitivity and/or bladder pain;

2)bladder pathology proven endoscopically by Hunner's ulcer and/or mucosal bleeding after over-distention; and

3) exclusion of confusable diseases." The term "hypersensitive bladder syndrome" is suggested for the symptom syndrome associated with IC or IC-like conditions, because hypersensitivity would be more inclusive than pain in that it incorporates both patients with and without pain.

In this guideline, three requirements for IC diagnosis are stated:

1) symptoms such as urinary frequency, hypersensitivity, and/or bladder pain;

2) cystoscopic findings proving pathologies in the urinary bladder and

3) exclusion of other confusable diseases explainable for the symptoms and findings.

Mandatory for diagnosis are clinical history, physical examinations, and urinalysis. Recommended are urine culture, urine cytology, symptom scores, quality of life scores, frequency-volume chart, residual urine measurement, prostate specific antigen, cystoscopy and/or hydrodistention. Optional tests include ultrasonography, urodynamics, x-ray imaging, potassium testing, and bladder biopsy.

This Japanese guideline, the European Society for the Study of Interstitial Cystitis guidelines(1;2), and the American Urological Association guidelines that are currently in preparation will provide the substance of future deliberations and collaborations to help to design appropriate studies that will eventually result in effective treatment and possibly prevention of this disorder.

Homma Y, Ueda T, Ito T, Takei M, Tomoe H

Int J Urol. 2009 Jan;16(1):4-16.

UroToday Contributing Editor Philip M. Hanno, MD, MPH

Reference List
(1) Nordling J, Anjum FH, Bade JJ, Bouchelouche K, Bouchelouche P, Cervigni M, et al. Primary evaluation of patients suspected of having interstitial cystitis (IC). Eur Urol 2004 May;45(5):662-9.
(2) van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M, Daha LK, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol 2008 Jan;53(1):60-7.

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