Diagnosis

診斷

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. 基本評(píng)估應(yīng)包括仔細(xì)的病史詢問、體檢和實(shí)驗(yàn)室檢查，以確定因IC/BPS導(dǎo)致的癥狀，并排除其他易于混淆的疾病（詳見正文）。（臨床原則）

2. Baseline voiding symptoms and pain levels should be obtained in order to measure subsequent treatment effects. Clinical Principle

2. 應(yīng)該獲得并記錄基線排尿癥狀和疼痛水平評(píng)分，以便衡量后續(xù)的治療效果。（臨床原則）

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.膀胱鏡檢查和/或尿動(dòng)力學(xué)檢查對(duì)癥狀復(fù)雜的病例有助于診斷；在癥狀單純的病例中不必要必須依靠這些檢測(cè)來進(jìn)行診斷。（專家意見）

Treatment:

治療

Overall Management

總體方案

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. 治療策略應(yīng)首先采用無創(chuàng)的保守治療方法，如果癥狀控制不佳或者生活質(zhì)量的改善達(dá)不到可接受水平，再漸進(jìn)采用微創(chuàng)、有創(chuàng)的治療方法；由于外科治療的不可逆性，只有在嘗試所有無創(chuàng)的治療方案無效后，再選擇外科治療（電灼Hunner’s病變除外）才是合適的。在極為罕見的情況下，當(dāng)確診患者膀胱病變已到終末期，小膀胱攣縮并纖維化，病人的生活質(zhì)量提示一個(gè)正向的風(fēng)險(xiǎn)效益比時(shí)可以積極采取手術(shù)治療。（臨床原則）

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．初始治療的類型和強(qiáng)度應(yīng)取決于癥狀的嚴(yán)重程度、臨床醫(yī)生的判斷以及患者的治療傾向；治療流程切入點(diǎn)的選擇取決于上述這些因素。（臨床原則）

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，可以考慮同期進(jìn)行多種方法的聯(lián)合治療；基線時(shí)的癥狀評(píng)估和規(guī)律的重新評(píng)估癥狀變化對(duì)于評(píng)價(jià)單一和聯(lián)合治療的療效至關(guān)重要。（臨床原則）

7. Ineffective treatments should be stopped once a clinically meaningful interval has elapsed. Clinical Principle

7. 一旦有臨床意義的癥狀緩解間隔期消失，就應(yīng)該停止無效的治療。（臨床原則）

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. 由于疼痛管理對(duì)生活質(zhì)量的重要性，應(yīng)持續(xù)評(píng)估疼痛控制的有效性。如果疼痛緩解不充分，則應(yīng)考慮采用聯(lián)合治療，并向患者進(jìn)行適當(dāng)?shù)耐扑]。（臨床原則）

9. The IC/BPS diagnosis should be reconsidered if no improvement occurs after multiple treatment approaches. Clinical Principle

9. 如果經(jīng)過多種治療后癥狀沒有改善，應(yīng)當(dāng)重新考慮IC/BPS的診斷。（臨床原則）

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.

可選擇的治療方案：根據(jù)治療方案對(duì)患者的可能收益、潛在不良事件的風(fēng)險(xiǎn)和治療的可逆性三者之間的平衡，可以把治療方案分為一線、二線、三線、四線、五線和六線。有關(guān)治療方案的基本原理和研究詳情，請(qǐng)參閱指南正文。

First-Line Treatments: First-line treatments should be performed on all patients

一線治療：應(yīng)對(duì)所有患者進(jìn)行一線治療

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. 患者應(yīng)當(dāng)接受關(guān)于正常膀胱的功能、IC/BPS的已知和未知的信息、現(xiàn)有治療方案的收益/潛在風(fēng)險(xiǎn)比例方面知識(shí)的宣教。以及目前尚無對(duì)大多數(shù)患者單一治療療法有效的實(shí)際情況，在達(dá)到可接受的癥狀控制前可能需要嘗試多種治療方案（包括聯(lián)合治療）。（臨床原則）

11. Self-care practices and behavioral modifications that can improve symptoms should be discussed and implemented as feasible. Clinical Principle

11. 應(yīng)當(dāng)盡可能與患者交流并告知自我保健和行為治療可以改善癥狀。（臨床原則）

12. Patients should be encouraged to implement stress management practices to improve coping techniques and manage stress-induced symptom exacerbations. Clinical Principle

12.應(yīng)當(dāng)鼓勵(lì)患者疏解壓力，避免心理壓力導(dǎo)致的癥狀波動(dòng)。（臨床原則）

Second-line treatments

二線治療

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.具有經(jīng)過規(guī)范化培訓(xùn)治療師的機(jī)構(gòu)，應(yīng)當(dāng)向有盆底觸痛癥狀的患者提供適當(dāng)?shù)氖址ㄝo助物理治療（例如，手法緩解骨盆、腹部和/或臀部肌肉觸痛點(diǎn)疼痛、舒緩肌肉痙攣、緩解因疤痕和其他結(jié)締組織攣縮的導(dǎo)致疼痛）。應(yīng)避免強(qiáng)化盆底的運(yùn)動(dòng)（如凱格爾運(yùn)動(dòng)）。（臨床原則 標(biāo)準(zhǔn)）（證據(jù)強(qiáng)度A級(jí)）

14. Multimodal pain management approaches (e.g., pharmacological, stress management, manual therapy if available) should be initiated. Expert Opinion

14．如果有條件應(yīng)啟動(dòng)多學(xué)科疼痛管理模式（如藥理學(xué)、心理疏導(dǎo)壓力管理、手法輔助治療）。（專家意見）

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、羥嗪或戊糖多硫酸鹽類藥物可作為二線口服藥物（按字母順序排列，排名不分先后）。（可選）（證據(jù)強(qiáng)度B、B、C和B級(jí)）

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. 二甲基亞砜、肝素、或利多卡因膀胱灌注可以作為二線腔內(nèi)處理方法（按字母順序排列，排名不分先后）。（可選）（證據(jù)強(qiáng)度等級(jí)C、C和B）

Third-line treatments

三線治療

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. 如果一線和二線治療未達(dá)到可接受的癥狀控制和生活質(zhì)量改善，這時(shí)可以采用更具侵入性的治療方法，例如麻醉下膀胱鏡檢查的同時(shí)進(jìn)行短時(shí)、低壓的水?dāng)U張。（可選）（證據(jù)強(qiáng)度C級(jí)）

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病變，建議進(jìn)行病變部位電灼（激光或電凝）和/或注射曲安奈德。（推薦）（證據(jù)強(qiáng)度C級(jí)）

Fourth-line treatment

四線治療

BTX-A moved from fifth-line treatments to first fourth-line treatment

A型肉毒素注射從五線治療提升為四線治療

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.如果前述治療方法未能獲得足夠的癥狀控制和生活質(zhì)量改善，或者經(jīng)臨床醫(yī)生和患者協(xié)商后認(rèn)為需要這種方法改善癥狀，此時(shí)可以采用逼尿肌A型肉毒素注射。患者必須愿意接受A型肉毒素逼尿肌注射后自家間歇導(dǎo)尿的可能性。（可選）（證據(jù)強(qiáng)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. 如果其他治療方法未能獲得足夠的癥狀控制和生活質(zhì)量改善，或者經(jīng)臨床醫(yī)生和患者協(xié)商后認(rèn)為需要這種方法改善癥狀，可以嘗試進(jìn)行神經(jīng)刺激試驗(yàn)，如果有效則可以植入永久性神經(jīng)調(diào)控裝置。（可選）（證據(jù)強(qiáng)度C）

Fifth-line treatments

五線治療

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. 如果其他治療方法未能獲得足夠的癥狀控制和生活質(zhì)量改善，或者經(jīng)臨床醫(yī)生和患者協(xié)商后認(rèn)為需要這種方法改善癥狀，則環(huán)孢菌素A可以作為口服藥物使用。（可選）（證據(jù)強(qiáng)度C）

Sixth-line treatment

六線治療

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.對(duì)于所有其他治療未能獲得足夠的癥狀控制和生活質(zhì)量改善的患者，經(jīng)慎重選擇后可以實(shí)施大的手術(shù)治療（例如膀胱替代成形術(shù)、切除膀胱或不切除膀胱的尿流改道術(shù)）（參見上述指南第4條中的警告）。（可選）（證據(jù)強(qiáng)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.

不推薦的治療方法：以下治療方法缺乏確切的療效和/或伴有不可耐受的不良事件。有關(guān)治療方案的基本原理和研究詳情，請(qǐng)參閱指南正文。

23. Long-term oral antibiotic administration should not be offered. Standard (Evidence Strength- B)

23. 不推薦長(zhǎng)期口服抗生素治療。（標(biāo)準(zhǔn)）（證據(jù)強(qiáng)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，不推薦卡介苗（BCG）的膀胱灌注。（標(biāo)準(zhǔn)）（證據(jù)強(qiáng)度B）

25. High-pressure, long-duration hydrodistension should not be offered. Recommendation (Evidence Strength- C)

25. 不推薦長(zhǎng)時(shí)間、高壓的水?dāng)U張治療。（推薦）（證據(jù)強(qiáng)度C）

26. Systemic (oral) long-term glucocorticoid administration should not be offered. Recommendation (Evidence Strength- C)

26．不推薦長(zhǎng)期（口服）系統(tǒng)性全身糖皮質(zhì)激素給藥。（推薦）（證據(jù)強(qiáng)度C）

*翻譯僅供學(xué)習(xí)交流，不作為臨床實(shí)踐標(biāo)準(zhǔn)