Bladder pain syndrome: differences in diagnostic strategies around the world

Nomenclature for the syndrome commonly referred to as bladder pain syndrome is in flux. In the United States the disorder is interstitial cystitis/bladder pain syndrome reflecting one entity. This reflects the need to keep the term interstitial cystitis for health insurance purposes. In Europe bladder pain syndrome is now the well-accepted nomenclature. In Asia, the situation in more complex. The terms frequency/urgency syndrome, hypersensitive bladder syndrome, painful bladder syndrome, and interstitial cystitis all carry different connotations and overlap to some extent. A presumptive diagnosis requires a history compatible with the definition of symptoms, a physical examination, urinalysis, and exclusion of any confusable diseases. This is a major area of harmonization around the world. Further evaluation with cystoscopy and hydrodistention of the bladder is commonly done in Europe and Asia at the time of initial diagnosis, but is not considered mandatory. To further harmonize nomenclature, diagnosis, and treatment algorithms and enable international clinical research to improve therapies, the International Consultation on Incontinence recently organized a meeting in Tokyo, hosted by the International Continence Society meeting Sept. 2016, and a further meeting, the International Consultation on Interstitial Cystitis Japan is planned in April 2018 in Kyoto.