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1、Roadmaps of Roadmaps of interstitial cystitis and interstitial cystitis and other lower urinary other lower urinary tract dysfunctiontract dysfunction CY CY QuQu Dept Urology, Dept Urology, ChangzhengChangzheng Hospital, Hospital, SMMUSMMU qu_qu_There are five entities of lower urinary tract There a
2、re five entities of lower urinary tract dysfunction (LUTD) underlined together dysfunction (LUTD) underlined together for establishing clinical practice guidelines for establishing clinical practice guidelines 1. LUTS/BPH1. LUTS/BPH 2. overactive bladder (OAB)2. overactive bladder (OAB) 3. stress ur
3、inary incontinence/pelvic floor 3. stress urinary incontinence/pelvic floor prolapseprolapse (SUI/POP) (SUI/POP) 4. interstitial cystitis (IC)4. interstitial cystitis (IC) 5. geriatric incontinence (GI)5. geriatric incontinence (GI) SupplementSupplementAccording to the following description, Accordi
4、ng to the following description, two entities should be added into two entities should be added into LUTD, i.e.LUTD, i.e. 6. 6. detrusordetrusor underactivityunderactivity (DN) (DN) 7. sphincter 7. sphincter overactivityoveractivity (SO), formerly (SO), formerly dysfunctional voiding (DV) dysfunctio
5、nal voiding (DV) IC and LUTDIC and LUTDAmong the five entities, functional Among the five entities, functional disorder dominated in OAB, SUI, and disorder dominated in OAB, SUI, and GI, pathological or mechanical factors GI, pathological or mechanical factors may dominate in BPH and IC. may dominat
6、e in BPH and IC. Functional disorder may also result Functional disorder may also result from BPH and IC. We should always from BPH and IC. We should always take attention to organic as well as take attention to organic as well as functional elements in the diagnosis functional elements in the diagn
7、osis and treatment of LUTD.and treatment of LUTD. IC and LUTDIC and LUTDFunctional classification is very Functional classification is very important to important to neurogenicneurogenic or non- or non- neurogenicneurogenic LUTD. LUTD. EAU EAU lanchedlanched a classification system 2008 a classifica
8、tion system 2008 and proposed it for clinical practice. and proposed it for clinical practice. And we think its principle suited to nonAnd we think its principle suited to non - -neurogenicneurogenic LUTD too. LUTD too. The last two ones were marked The last two ones were marked as as “sphincter onl
9、y”,“sphincter only”, meaning meaning the original lesion is subtle or the original lesion is subtle or unknown. Sphincter unknown. Sphincter overactivityoveractivity or or underactivityunderactivity in in non-non-neurogenicneurogenic LUTD, i.e., LUTD, i.e., dysfunctional voiding (DV) or dysfunctiona
10、l voiding (DV) or intrinsic sphincter deficiency intrinsic sphincter deficiency （ISDISD）, have the same , have the same meaning.meaning.Old standard for interstitial cystitisOld standard for interstitial cystitis(1988) (1988)New name (PBS/ICNew name (PBS/IC）and its and its definition (confirmed in M
11、ay 2007).definition (confirmed in May 2007).PBS/IC would be diagnosed on the basis of PBS/IC would be diagnosed on the basis of chronic chronic pelvic painpelvic pain, pressure or discomfort perceived to be , pressure or discomfort perceived to be related to the urinary bladder accompanied by at lea
12、st related to the urinary bladder accompanied by at least one other urinary symptoms like one other urinary symptoms like persistent urge topersistent urge to void or urinary frequencyvoid or urinary frequency. Confusable diseases as the . Confusable diseases as the cause of the symptoms must be exc
13、luded. Further cause of the symptoms must be excluded. Further documentation and classification of PBS/IC might be documentation and classification of PBS/IC might be performed according to findings at performed according to findings at cystoscopycystoscopy with with hydrodistentionhydrodistention a
14、nd morphological findings in bladder and morphological findings in bladder biopsies. biopsies. Changes of name and meaningChanges of name and meaning Diagnosis methodDiagnosis methodThe potassium chloride test, an The potassium chloride test, an intravesicalintravesical challenge comparing challenge
15、 comparing the sensory nerve provocative the sensory nerve provocative ability of saline versus potassium ability of saline versus potassium chloride using a 0.4M-KCl chloride using a 0.4M-KCl solution, has not gained solution, has not gained acceptance as a diagnostic test for acceptance as a diagn
16、ostic test for a variety of reasons.a variety of reasons.Diagnosis methodDiagnosis methodAs the new century dawned, As the new century dawned, there was much confusion as to there was much confusion as to how to define this 100-year-old how to define this 100-year-old syndrome, and the need for a syndrome, and the need for a clinically useful, universally clinically useful, universally accepted way to characterize accepted way to characterize IC took to the forefront.IC
