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DIAGNOSIS AND TREATMENT OF INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME Guideline statements Diagnosis 诊断 1. The basic assessment should include a careful history, physical examination, and laboratory examination to rule in symptoms that characterize IC/BPS and rule out other confusable disorders (see text for details). Clinical Principle 1. 基本评估应包括仔细的病史询问、体检和实验室检查，以确定因IC/BPS导致的症状，并排除其他易于混淆的疾病（详见正文）。（临床原则） 2. Baseline voiding symptoms and pain levels should be obtained in order to measure subsequent treatment effects. Clinical Principle 2. 应该获得并记录基线排尿症状和疼痛水平评分，以便衡量后续的治疗效果。（临床原则） 3. Cystoscopy and/or urodynamics should be considered as an aid to diagnosis only for complex presentations; these tests are not necessary for making the diagnosis in uncomplicated presentations. Expert Opinion 3.膀胱镜检查和/或尿动力学检查对症状复杂的病例有助于诊断；在症状单纯的病例中不必要必须依靠这些检测来进行诊断。（专家意见） Treatment: 治疗 Overall Management 总体方案 4. Treatment strategies should proceed using more conservative therapies first, with less conservative therapies employed if symptom control is inadequate for acceptable quality of life; because of their irreversibility, surgical treatments (other than fulguration of Hunner’s lesions) are appropriate only after other treatment alternatives have been exhausted, or at any time in the rare instance when an end-stage small, fibrotic bladder has been confirmed and the patient’s quality of life suggests a positive risk-benefit ratio for major surgery. Clinical Principle 4. 治疗策略应首先采用无创的保守治疗方法，如果症状控制不佳或者生活质量的改善达不到可接受水平，再渐进采用微创、有创的治疗方法；由于外科治疗的不可逆性，只有在尝试所有无创的治疗方案无效后，再选择外科治疗（电灼Hunner’s病变除外）才是合适的。在极为罕见的情况下，当确诊患者膀胱病变已到终末期，小膀胱挛缩并纤维化，病人的生活质量提示一个正向的风险效益比时可以积极采取手术治疗。（临床原则） 5. Initial treatment type and level should depend on symptom severity, clinician judgment, and patient preferences; appropriate entry points into the treatment portion of the algorithm depend on these factors. Clinical Principle 5．初始治疗的类型和强度应取决于症状的严重程度、临床医生的判断以及患者的治疗倾向；治疗流程切入点的选择取决于上述这些因素。（临床原则） 6. Multiple, simultaneous treatments may be considered if it is in the best interests of the patient; baseline symptom assessment and regular symptom level reassessment are essential to document efficacy of single and combined treatments. Clinical Principle 6. 如果符合患者的最佳利益，可以考虑同期进行多种方法的联合治疗；基线时的症状评估和规律的重新评估症状变化对于评价单一和联合治疗的疗效至关重要。（临床原则） 7. Ineffective treatments should be stopped once a clinically meaningful interval has elapsed. Clinical Principle 7. 一旦有临床意义的症状缓解间隔期消失，就应该停止无效的治疗。（临床原则） 8. Pain management should be continually assessed for effectiveness because of its importance to quality of life. If pain management is inadequate, then consideration should be given to a multidisciplinary approach and the patient referred appropriately. Clinical Principle 8. 由于疼痛管理对生活质量的重要性，应持续评估疼痛控制的有效性。如果疼痛缓解不充分，则应考虑采用联合治疗，并向患者进行适当的推荐。（临床原则） 9. The IC/BPS diagnosis should be reconsidered if no improvement occurs after multiple treatment approaches. Clinical Principle 9. 如果经过多种治疗后症状没有改善，应当重新考虑IC/BPS的诊断。（临床原则） Treatments that may be offered: Treatments that may be offered are divided into first-, second-, third-, fourth-, fifth-, and sixth-line groups based on the balance between potential benefits to the patient, potential severity of adverse events (AEs) and the reversibility of the treatment. See body of guideline for protocols, study details, and rationales. 可选择的治疗方案：根据治疗方案对患者的可能收益、潜在不良事件的风险和治疗的可逆性三者之间的平衡，可以把治疗方案分为一线、二线、三线、四线、五线和六线。有关治疗方案的基本原理和研究详情，请参阅指南正文。 First-Line Treatments: First-line treatments should be performed on all patients 一线治疗：应对所有患者进行一线治疗 10. Patients should be educated about normal bladder function, what is known and not known about IC/ BPS, the benefits v. risks/burdens of the available treatment alternatives, the fact that no single treatment has been found effective for the majority of patients, and the fact that acceptable symptom control may require trials of multiple therapeutic options (including combination therapy) before it is achieved. Clinical Principle 10. 患者应当接受关于正常膀胱的功能、IC/BPS的已知和未知的信息、现有治疗方案的收益/潜在风险比例方面知识的宣教。以及目前尚无对大多数患者单一治疗疗法有效的实际情况，在达到可接受的症状控制前可能需要尝试多种治疗方案（包括联合治疗）。（临床原则） 11. Self-care practices and behavioral modifications that can improve symptoms should be discussed and implemented as feasible. Clinical Principle 11. 应当尽可能与患者交流并告知自我保健和行为治疗可以改善症状。（临床原则） 12. Patients should be encouraged to implement stress management practices to improve coping techniques and manage stress-induced symptom exacerbations. Clinical Principle 12.应当鼓励患者疏解压力，避免心理压力导致的症状波动。（临床原则） Second-line treatments 二线治疗 13. Appropriate manual physical therapy techniques (e.g., maneuvers that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures, and release painful scars and other connective tissue restrictions), if appropriately-trained clinicians are available, should be offered to patients who present with pelvic floor tenderness. Pelvic floor strengthening exercises (e.g., Kegel exercises) should be avoided. Clinical Principle Standard (Evidence Strength- Grade A) 13.具有经过规范化培训治疗师的机构，应当向有盆底触痛症状的患者提供适当的手法辅助物理治疗（例如，手法缓解骨盆、腹部和/或臀部肌肉触痛点疼痛、舒缓肌肉痉挛、缓解因疤痕和其他结缔组织挛缩的导致疼痛）。应避免强化盆底的运动（如凯格尔运动）。（临床原则 标准）（证据强度A级） 14. Multimodal pain management approaches (e.g., pharmacological, stress management, manual therapy if available) should be initiated. Expert Opinion 14．如果有条件应启动多学科疼痛管理模式（如药理学、心理疏导压力管理、手法辅助治疗）。（专家意见） 15. Amitriptyline, cimetidine, hydroxyzine, or pentosan polysulfate may be administered as second-line oral medications (listed in alphabetical order; no hierarchy is implied). Options (Evidence Strength- Grades B, B, C, and B) 15. 阿米替林、西米替丁、羟嗪或戊糖多硫酸盐类药物可作为二线口服药物（按字母顺序排列，排名不分先后）。（可选）（证据强度B、B、C和B级） 16. DMSO, heparin, or lidocaine may be administered as second-line intravesical treatments (listed in alphabetical order; no hierarchy is implied). Option (Evidence Strength- Grades C, C, and B) 16. 二甲基亚砜、肝素、或利多卡因膀胱灌注可以作为二线腔内处理方法（按字母顺序排列，排名不分先后）。（可选）（证据强度等级C、C和B） Third-line treatments 三线治疗 17. Cystoscopy under anesthesia with short-duration, low-pressure hydrodistension may be undertaken if first- and second-line treatments have not provided acceptable symptom control and quality of life or if the patient’s presenting symptoms suggest a more invasive approach is appropriate. Option (Evidence Strength- Grade C) 17. 如果一线和二线治疗未达到可接受的症状控制和生活质量改善，这时可以采用更具侵入性的治疗方法，例如麻醉下膀胱镜检查的同时进行短时、低压的水扩张。（可选）（证据强度C级） 18. If Hunner’s lesions are present, then fulguration (with laser or electrocautery) and/or injection of triamcinolone should be performed. Recommendation (Evidence Strength- Grade C) 18. 如果存在Hunner’s病变，建议进行病变部位电灼（激光或电凝）和/或注射曲安奈德。（推荐）（证据强度C级） Fourth-line treatment 四线治疗 BTX-A moved from fifth-line treatments to first fourth-line treatment A型肉毒素注射从五线治疗提升为四线治疗 19. Intradetrusor botulinum toxin A (BTX-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. Patients must be willing to accept the possibility that post-treatment intermittent self- catheterization may be necessary. Option (Evidence Strength- C) 19.如果前述治疗方法未能获得足够的症状控制和生活质量改善，或者经临床医生和患者协商后认为需要这种方法改善症状，此时可以采用逼尿肌A型肉毒素注射。患者必须愿意接受A型肉毒素逼尿肌注射后自家间歇导尿的可能性。（可选）（证据强度C） 20. A trial of neurostimulation may be performed and, if successful, implantation of permanent neurostimulation devices may be undertaken 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. Option (Evidence Strength- C) 20. 如果其他治疗方法未能获得足够的症状控制和生活质量改善，或者经临床医生和患者协商后认为需要这种方法改善症状，可以尝试进行神经刺激试验，如果有效则可以植入永久性神经调控装置。（可选）（证据强度C） Fifth-line treatments 五线治疗 21. Cyclosporine A may be administered as an oral medication 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. Option (Evidence Strength- C) 21. 如果其他治疗方法未能获得足够的症状控制和生活质量改善，或者经临床医生和患者协商后认为需要这种方法改善症状，则环孢菌素A可以作为口服药物使用。（可选）（证据强度C） Sixth-line treatment 六线治疗 22. Major surgery (e.g., substitution cystoplasty, urinary diversion with or without cystectomy) may be undertaken in carefully selected patients for whom all other therapies have failed to provide adequate symptom control and quality of life (see caveat above in guideline statement #4). Option (Evidence Strength- C) 22.对于所有其他治疗未能获得足够的症状控制和生活质量改善的患者，经慎重选择后可以实施大的手术治疗（例如膀胱替代成形术、切除膀胱或不切除膀胱的尿流改道术）（参见上述指南第4条中的警告）。（可选）（证据强度C） Treatments that should not be offered: The treatments below appear to lack efficacy and/or appear to be accompanied by unacceptable AE profiles. See body of guideline for study details and rationales. 不推荐的治疗方法：以下治疗方法缺乏确切的疗效和/或伴有不可耐受的不良事件。有关治疗方案的基本原理和研究详情，请参阅指南正文。 23. Long-term oral antibiotic administration should not be offered. Standard (Evidence Strength- B) 23. 不推荐长期口服抗生素治疗。（标准）（证据强度-B） 24. Intravesical instillation of bacillus Calmette-Guerin (BCG) should not be offered outside of investigational study settings. Standard (Evidence Strength- B) 24. 除非出于研究目的，不推荐卡介苗（BCG）的膀胱灌注。（标准）（证据强度B） 25. High-pressure, long-duration hydrodistension should not be offered. Recommendation (Evidence Strength- C) 25. 不推荐长时间、高压的水扩张治疗。（推荐）（证据强度C） 26. Systemic (oral) long-term glucocorticoid administration should not be offered. Recommendation (Evidence Strength- C) 26．不推荐长期（口服）系统性全身糖皮质激素给药。（推荐）（证据强度C） *翻译仅供学习交流，不作为临床实践标准 |
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