Editing CUA: Interstitial Cystitis (2016) (section)

=== Optional (5): ===
* '''Post-void residual'''
** '''Recommended with a history of poor emptying and/or palpable bladder'''
* '''Urine cytology'''
** '''Indicated if microscopic hematuria is present or if there are other risk factors for urothelial carcinoma'''
* '''Imaging'''
** '''Abdominal or pelvic ultrasonography, or other imaging modalities, may be useful when alternative clinical conditions are questioned, but are expected to be normal if IC/BPS is the only diagnosis.'''
* '''Intravesical anesthetic challenge'''
** '''An anesthetic challenge test, such as an alkalized lidocaine test, instills 10‒20 mL of an anesthetic mixture into an empty bladder. This fluid is held for 10‒15 minutes and then drained by catheter.'''
** '''This test can be performed after cystoscopy and can provide both relief to the patient, as well as diagnostic information and guide future therapy.'''
* '''Hydrodistension (HD)'''
** '''Performed under general or regional anesthetic'''
** '''Bladder is filled with NS by gravity drainage at a pressure of 80 cm H2O to its maximum anesthetic capacity (determined whereby the inflow backs up in the drip chamber or leakage occurs per urethra despite compression against the cystoscope) and distension is maintained for 2 to no more than 10 minutes; the bladder is drained at the end and capacity is measured'''
** '''HD under general anesthetic allows for stratification of patients into those with ulcers and glomerulations from those with no obvious mucosal abnormalities'''
** '''As the literature is conflicting regarding its utility, HD for diagnostic purposes may be appropriate in certain situations such as:'''
*** '''Patient is unable to tolerate cystoscopy under local anesthetic and is having a general anesthetic'''
*** '''When a patient has failed other treatment options and HD to assess disease severity may contribute information to the diagnosis'''
*** '''Assessing a patient for clinical trial eligibility'''