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Bladder pain syndrome is a clinical condition with many aspects to its presentation and numerous suggested treatments, many of which remain controversial. Reconstructive surgery should only be considered when all the conservative options have been exhausted and only after careful counselling. The purpose of this review is to demonstrate the current evidence in the surgical management of this disease, preparatory to which we have reviewed the surgical aspects. For medical treatment, the evidence base is of poor quality and based on case series. Nevertheless, in carefully selected patients after appropriate counselling, excellent results can be achieved both with total cystectomy and augmentation cystoplasty or a continent or incontinent diversion. We reviewed the various success rates of the treatments which are described. A multidisciplinary approach is essential to a successful outcome, and it is essential to consider not only the urological, but also broader medical and psychological consequences seen with bladder pain syndrome. Further research should focus on clearly categorizing the patients with well-defined clinical criteria to provide high-quality evidence to support the selection of the most effective treatment.

Current bladder dysfunction reports (2019). doi:10.1007/s11884-019-00531-w, Published by Current Medicine Group, Philadelphia, Pa.

The primary treatment of lower urinary tract symptoms thought to be associated with histological benign prostatic hyperplasia causing bladder outflow obstruction (LUTS/BPH) has evolved from an emphasis on surgical through to medical therapies. More recently there has been an increasing trend toward developing combination pharmacotherapy utilizing agents with differing mechanism of action aimed at the various pathophysiolgies potentially underpinning voiding and storage symptoms. The focus has been on clinical benefit such as reducing disease progression, acute urinary retention and need for BPH surgery in the case of alpha-blockers (AB) and 5-alpha-reductase inhibitor combination. This effect appears to be appropriate in the subset of men with larger prostates. Anti-muscarinics with AB is safe and effective treatment in those with bothersome storage symptoms and LUTS/BPH, although only confirmed as not associated with retention based on the existing literature for men with low PVR’s