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GIBS releases clinical practice guidelines for rare disease, IC/BPS for healthcare professionals

Laxmi Yadav, Mumbai
Tuesday, September 5, 2017, 08:00 Hrs  [IST]

In a first of its kind initiative in the country, the Global Interstitial Cystitis Bladder Pain Society (GIBS), division of Swati Orphan Disease Foundation, has released clinical practice guidelines for rare disease, interstitial cystitis/bladder pain syndrome (IC/BPS) for the healthcare professionals across the specialties that are committed to treating the misery of patients with bladder pain syndrome.

The guidelines were released by president elect of Urological Society India, Dr Azit Vaze at second scientific conference on IC/BPS “GIBS -2017” in Mumbai recently. It will streamline the diagnosis process in order to shorten assessment time for the disease and subsequently avoid delay in treatment. The guidelines have been developed by the panel of eight doctors comprising of leading expert urologists and gynecologists of the country, led by Dr Rajesh Taneja, chairperson-GIBS & Dr Sanjay Pandey, secretary –GIBS.

IC/BPS is a disease which affects bladder and pelvic organs and makes patients run again and again to pass urine because they can’t control it just because feeling of bladder gives them a lot of pain. With the symptoms progressing, many such patients get wrongly treated as urinary infections. Timely identification of the disease is need of the hour to end suffering of the patients.

The disease does not have diagnosis criteria. Patients approaching urologists for the treatment after visiting 8-10 doctors. More than 70 per cent women suffer from IC/BPS. Initially they approach gynecologists who don’t know the subject. The guidelines help gynecologists diagnose and treat the disease at the earliest.

The doctors, if armed with latest technology, can diagnose the case properly and extend the right treatment without losing any time, said Dr Sanjay Pandey.

The guidelines have been divided into varied segments including definition, clinical approach, treatment procedures.

According to the guidelines, there are certain symptoms of IC/BPS patients which include pain or discomfort in lower abdomen and / or urogenital area of more than 3 months duration which is worst on full bladder. It accompanies by one or more lower urinary tract irritative symptoms like frequency, urgency, nocturia, with or without standard stigmata on cytoscopy, provided that another discernable pathology likely to cause these symptoms has been excluded.

Considering Indian scenario, the GIBS council has proposed the following guidelines for investigating a suspected case of IC/BPS.

Diagnostic tests of IC/BPS proposed by the council include certain mandatory tests viz. Clinical history, physical examinations, frequency volume chart, urinalysis, ultrasonography. It also recommended certain tests in selected cases which include urine culture, urine cytology, symptom scores, QOL scores, frequency volume chart, cystoscopy. Urodynamic study and bladder biopsy are optional tests which can be considered as the case may be.

One day frequency volume chart is also an important preliminary investigation that can give a fair about the function of the urinary bladder. Frequency volume chart involves measurement of voided urine and fluid intake with respect to time accompanied by remarks such as pain, leak etc. A record of 24 hours starting from the second void of the day to the first void of the next day is sufficient and practical.

The council proposed inclusion of ultrasonography as mandatory test for diagnosis of IC/BPS. This will avoid over diagnosis of IC/BPS as well as chances of missing many pelvic pathologies requiring immediate attention eg. one can also rule out high residual urine (occult retention). This eventually will be cost effective as inappropriate treatments can be avoided, especially when regular follow up is missing in periphery.

It agreed Urinalysis to be as essential test in all patients but recommend Urine culture only in presence of high suspicion e.g. positive nitrates, Leukocyte Esterase and/or significant pus cells due to high sensitivity and specificity of these values for diagnosing urinary tract infection (UTI).

The treatment guidelines include patient education, counseling, behavioral therapy, diet manipulation, management of chronic pain, avoiding painful bladder flares.

While being treated for IC, patients may be prescribed a combination of medications for optimal symptom control.


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