AUA IC/BPS guideline update highlights new data

The AUA has updated its guideline on interstitial cystitis/bladder pain syndrome, with changes primarily focusing on aspects of treatment for a condition that affects three to eight million women and one to four million men in the United States.

Updates reflect new data published in recent years, according to the chair of the guideline panel.

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The updates were announced in September to coincide with National Interstitial Cystitis Awareness Month, the AUA said in a press release. Among the amendments to the guideline:

• In the “Second Line Treatment” section, a statement was updated to indicate that physical therapy techniques should be offered to a specific target population, namely patients who present with pelvic floor tenderness. Appropriate manual physical therapy techniques are defined as maneuvers that resolve pelvic, abdominal, and/or hip muscular trigger points; lengthen muscle contractures; and release painful scars and other connective tissue restrictions. In addition, the evidence level for this statement was upgraded to a Standard, Evidence Strength Grade A.

• A “Fifth Line Treatment” statement about the use of intradetrusor botulinum toxin A (Botox) was moved to a “Fourth Line Treatment” statement. Botulinum toxin A “may be administered if other treatments have not provided adequate symptom control and quality of life or if the clinician and patient agree that symptoms require this approach,” according to the guideline. Intermittent self-catheterization may be necessary following this treatment, the guideline says.
  “Based on the literature review and consensus of the majority of guideline panel members, botulinum toxin A was moved from a fifth-line therapy recommendation to fourth line as an option to neurostimulation, which remains a fourth-line therapy,” guideline panel chair and Philip M. Hanno, MD, MPH, told Urology Times.

• A statement about intravesical resiniferatoxin initially included as part of the “Treatments not to be offered” section was removed from the guideline. This agent is not available in the United States.

Additionally, minor revisions to the guideline include the addition of new literature to the IC/BPS symptoms discussion, inclusion of new text to the Hunner’s lesions and cystoscopy discussion, and presentation of new evidence in the discussion of neurostimulation.

Next: Dr. Hanno discusses updates

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Dr. Hanno, of the University of Pennsylvania, Philadelphia, said the guideline updates “highlight new data published over the last few years, much of which helps to substantiate the guideline recommendations already published.”

“Of course, these guidelines remain a work in progress and are subject to individual provider and patient decisions regarding what treatment best fits an individual’s particular clinical circumstances at any given time. Hopefully, the next iteration of the guidelines will be able to highlight new therapies not yet available or existing therapies not yet shown to be efficacious,” said Dr. Hanno, who also serves as an editorial consultant to Urology Times.

The amendments were made as part of the AUA’s Update Literature Review process. A complete executive summary for the guideline amendments will be published in an upcoming issue of the Journal of Urology. Additionally, the AUA said a webinar about the updated guideline is forthcoming and will be available online at www.AUAnet.org.

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