What are the subgroups of interstitial cystitis/bladder pain syndrome (IC/BPS)?

Updated: Dec 04, 2020
  • Author: Eric S Rovner, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Clinically, interstitial cystitis is often divided into 2 distinct subgroups based on findings at cystoscopy and bladder overdistention. These categories are the ulcerative (ie, classic) and nonulcerative (ie, Messing-Stamey) types. Such differences may have important implications for diagnosis and therapy. Evidence showing progression of ulcerative to nonulcerative disease, or vice versa, is lacking. [20] Clinical presentation is also variable, with nonulcerative patients presenting with a more diffuse pain syndrome and multiple systemic complaints. Ulcerative patients tend to have higher daytime and nighttime frequency and lower bladder capacity, indicating that it may be more of a condition of the bladder itself than the nonulcerative type. [21]

As such, the ulcerative subtype responds better to bladder-targeted therapies, including cauterization [22] and cystectomy. [23] Cystectomy has also led to significant improvements in quality of life in patients with severe ulcerative interstitial cystitis. [21] Fulguration may provide significant long-term benefit in patients with ulcerative disease if the ulcers involve less than 25% of the bladder. However, a significant subpopulation requires repeat treatment, and many of those patients progress to cystectomy. [24]


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