International Urogynecology Journal

, Volume 30, Issue 11, pp 1795–1805 | Cite as

Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines

  • Janna Pape
  • Gabriele Falconi
  • Thais Regina De Mattos Lourenco
  • Stergios K. Doumouchtsis
  • Cornelia BetschartEmail author
Review Article


Introduction and hypothesis

Interstitial cystitis (IC) and bladder pain syndrome (BPS) are challenging and encompassing hypersensitivity disorders of the lower urinary tract. A variety of national and international guidelines have been published including guidance on nomenclature, definitions, etiopathology, diagnostics and treatment. A lack of universally established clinical guidance is apparent. The aim of this review is to evaluate key guidelines on this area of practice, identify variations, compare their recommendations and grade them using AGREE II.


Literature searches were performed using the PUBMED and CINAHL database from January 1, 1983, to December 1, 2018, referring to the search strategy of AUA. Ten national and international guidelines were included into the analysis. We assessed the guidelines with the updated AGREE II.


Symptoms congruent in all guidelines are: pain, pressure, discomfort and frequency, urgency and nocturia. Urinalysis is a prerequisite for diagnostics, cystoscopy for most and urodynamics not part of the routine assessment. Treatment options are recommended stepwise. The highest level of evidence and consensus was identified for oral therapies. Nine guidelines had an overall quality score ≥ 50% and three scored ≥ 70% (AUA, GG, RCOG).


The guidelines are congruent in symptom reporting, quite congruent in diagnostics and vary to a high degree on treatment recommendations. The complexity of BPS and emerging evidence indicate the need for regular updating of the guidelines and a wider consensus.


Bladder pain syndrome Interstitial cystitis Diagnostics Treatment Guidelines AGREE II 


Compliance with ethical standards

Conflicts of interest


Details of ethics approval

There is no need for ethical approval for a systematic review.


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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  • Janna Pape
    • 1
  • Gabriele Falconi
    • 2
  • Thais Regina De Mattos Lourenco
    • 3
  • Stergios K. Doumouchtsis
    • 4
    • 5
  • Cornelia Betschart
    • 1
    Email author
  1. 1.Department of GynecologyUniversity Hospital of ZurichZurichSwitzerland
  2. 2.Department of Obstetrics and Gynecology“San Bortolo” HospitalVicenzaItaly
  3. 3.Department of Obstetrics and Gynecology, Urogynaecology DivisionUniversity of Sao PauloSao PauloBrazil
  4. 4.Department of Obstetrics and GynaecologyEpsom and St Helier University Hospitals NHS TrustLondonUK
  5. 5.St George’s University of LondonLondonUK

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