Evaluation of patients with painful bladder syndrome/interstitial cystitis

This review looks into the evaluation of patients with interstitial cystitis (IC). IC is not easy to define. There is a lot of activity in this domain and a great international effort is being made to get to a generally accepted definition and standardized protocols for diagnosis and treatment. We have not reached this point so far. The diagnosis is still one of exclusion, but a search for specific markers may change this. Until then, other conditions have to be looked for and the list of these is not short. A primary evaluation with history taking, symptom scores, clinical investigations, and urine tests can guide the physician to further testing. Urodynamic tests, cystoscopy and hydrodistension, biopsies, and pathologic evaluation are in the process of finding a place in the diagnostic tree. The potassium test seems useful for the evaluation of bladder permeability, but is not specific for IC alone. Studies on re-evaluation in patients with IC show that primary misdiagnosis happens in a number of them. This is an extra motivation to continue the work towards standardization of the diagnostic and therapeutic approach.