The Wake Forest Institute for Regenerative Medicine organized the Global Consensus conference in Winston-Salem, North Carolina, in April 2025. It aimed to set targets for the definition, phenotyping, diagnosis, and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). Under the guidance of Dr. Rajesh Taneja, the subcommittee has focused on developing consensus documents on IC/BPS in males.
IC/BPS was initially thought to affect females primarily. Current research challenges this notion and reveals an increasing identification of IC/BPS in males. The prevalence may vary due to variations in definitions, diagnostic standards, and the population studied. Anger et al. reported a 500-fold difference in prevalence estimates for males compared to a 150-fold variation in females, which highlights the lack of agreement in the identification and diagnosis of IC/BPS.
Much research has shown the prevalence rate of males with IC/BPS. The 2007 National Health Interview Survey investigated 60 cases per 100,000 males, resulting in 82,000 affected individuals. The Boston Area Community Health discovered 2.6% of females and 1.3% of males were affected, while Veterans Affairs data indicated a national rate of 0.66%. The RAND research indicated a men’s prevalence rate of 1.9 to 4.2%.
Research on IC/BPS in males remains limited due to the reliance on self-reported symptoms and difficulties in distinguishing between healthcare-registered and general data, which necessitate more standardized and rigorous studies.
Diagnosis of IC/BPS in males is challenging because of the overlapping of symptoms with other urological diseases, mainly epididymitis, bladder outlet obstruction, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Many males presenting with urinary symptoms are misdiagnosed with prostate, which leads to 48% of IC/BPS cases being diagnosed as prostatitis, and half go on to undergo unnecessary prostate surgery, such as TURP.
Males have more severe IC/BPS symptoms with CPPS-like urinary frequency, suprapubic pain, forceful voiding, and nocturia. IC/BPS causes severe pain in delayed urination and leads to disrupted sleep. The pain may radiate to the lower back, perineum, and scrotum and have a neuropathic or burning character. Pain during bladder filling significantly suggests IC/BPS and pain during urination indicates CP/CPPS.
A physical examination can detect discomfort in the perineum, the anterior rectal wall, and the suprapubic area. Prostate discomfort is infrequent in the chronic cases. Mapping these painful areas assists in diagnosis and treatment. Both CP/CPPS and IC/BPS are known under the broader category of Urologic Chronic Pelvic Pain Syndrome (UCPPS).
Research indicates many IC/BPS phenotypes, with the bladder-centric subtypes associated with high pain scores, reduced bladder capacity, and Hunner lesions, and the non-bladder-centric subtypes associated with systemic diseases like IBS, fibromyalgia, mental health disease, and chronic fatigue syndrome. About 60% of males with IC/BPS showed sexual dysfunction.
A bladder diary is evaluated by assessing voiding capacity and frequency, followed by midstream cultures and urinalysis to rule out hematuria or infection. If chronic bacterial prostatitis is identified, specific tests, such as the two-glass test or the Meares-Stamey four-glass test, are utilized. Imaging using video urodynamics, uroflowmetry, and bladder ultrasound can help identify lower urinary tract dysfunction or obstruction. The PSA test is performed with caution in males over 50 years of age. MRI may be necessary for neurological involvement.
Treatment of the IC/BPS in males is diverse. The first step involves educating the patient, reducing stress, making dietary changes, and providing psychological support. Cystoscopy is a reliable method for diagnosing Hunner lesions, and it is recommended for the early diagnosis process. Therapeutic procedures with anesthesia can involve lesion ablation, intravesical steroid injection, and hydrodistension. Pharmacological treatments involve tricyclic antidepressants (amitriptyline), alpha-blockers, urinary alkalizers, hydroxyzine, and gabapentinoids. A recent study has shown that β3 agonists and anticholinergics are safer in males. The only FDA-approved oral medication is Pentosan polysulfate to treat IC/BPS. It has mixed effectiveness and carries a risk of retinal damage with prolonged use.
Males with overactivity of the pelvic floor can benefit from muscle relaxants like clonazepam and cyclobenzaprine or physical therapy. Research on intravesical therapies, such as neuromodulation and botulinum toxin, is insufficient for males. Experimental treatments, such as platelet-rich plasma (PRP) and stem cell therapy, are still being investigated.
Male-specific IC/BPS data have limitations due to a lack of representation, small sample sizes, and the absence of gender-based analysis. Future research should focus on developing phenotype-based therapies and applying standardized clinical assessment systems. Potential treatment options include bladder-lining repair medications (such as chondroitin sulfate and hyaluronic acid), new neuromodulation techniques, and regenerative medicine. Addressing these gaps is critical to improve diagnosis and treatment for males with IC/BPS.
Reference: Snipes M, Whitman W, Pontari M, Anger J, Samarinas M, Taneja R. Interstitial cystitis/bladder pain syndrome in men. Neurourol Urodyn. 2025. doi:10.1002/nau.70103
