女性盆腔疾病:间质性膀胱炎/膀胱疼痛综合症

Q3 Medicine FP essentials Pub Date : 2024-12-01
Estefan Beltran
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摘要

间质性膀胱炎/膀胱疼痛综合征(IC/BPS)是一种可能未被诊断的慢性疼痛综合征,在没有感染或其他可识别原因的情况下,由持续超过6周的盆腔疼痛加上下尿路症状组成。40岁以后更常见。病因尚不清楚,但一些患者的膀胱有炎性发现,称为亨纳病变。由于其不同的表现,没有标准化的评估诊断IC/BPS。病史应包括疼痛和泌尿系统症状;相关合并症,包括自身免疫和精神健康状况;以及提示其他原因(如感染)的症状。膀胱镜检查不需要,但对于有难治性症状和怀疑有Hunner病变的患者,如年龄大于50岁或合并自身免疫性疾病和/或以膀胱为中心的患者(如尿急、尿频、尿量少),应考虑进行膀胱镜检查。治疗通常是多模式的,包括行为改变、压力管理和非药物治疗(如盆底物理治疗)。可以考虑口服药物治疗,但没有关于首选药物的指南。难治性病例也可考虑转诊进行程序性治疗。患者应该明白,没有任何治疗是绝对成功的,复发和突然发作经常发生。
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Female Pelvic Conditions: Interstitial Cystitis/Bladder Pain Syndrome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a likely underdiagnosed chronic pain syndrome consisting of pelvic pain lasting longer than 6 weeks plus lower urinary tract symptoms in the absence of infection or other identifiable cause. It is more common after 40 years of age. The etiology is unclear, but some patients have inflammatory findings in the bladder known as Hunner lesions. Due to its variable presentation, there is no standardized evaluation for diagnosis of IC/BPS. The history should include pain and urinary symptoms; associated comorbid disorders, including autoimmune and mental health conditions; and symptoms suggestive of other causes (eg, infection). Cystoscopy is not required but should be considered for patients with refractory symptoms and when Hunner lesions are suspected, such as in those older than 50 years or with comorbid autoimmune disorders and/or bladder-centric presentation (eg, predominance of urgency, frequency, low urine volumes). Treatment is often multimodal, including behavior modifications, stress management, and nonpharmacologic therapy (eg, pelvic floor physical therapy). Oral pharmacotherapy can be considered, but no guidelines exist on preferred agents. Referral for procedural treatments can also be considered for refractory cases. Patients should understand that no treatments are definitively successful, and recurrences and flare-ups often occur.

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FP essentials
FP essentials Medicine-Medicine (all)
CiteScore
1.00
自引率
0.00%
发文量
58
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