Bridging the international IC/BPS guidelines: A practical phenotype-based framework for everyday urologic practice

Interstitial cystitis/bladder pain syndrome is a heterogeneous chronic condition with variable guideline-based diagnoses and treatments. Herein, we compared the guidelines of the American Urological Association, European Association of Urology, and Canadian Urological Association to identify discrepancies and develop a practical framework. A structured narrative synthesis of the three guidelines was conducted alongside selected peer-reviewed studies and expert consensus. Diagnostic and treatment approaches were compared and reconciled using a phenotypic framework. The Canadian Urological Association adopts phenotype-based management, the European Association of Urology supports European Society for the Study of Interstitial Cystitis subtyping, and the American Urological Association emphasizes individualized non-tiered care. Phenotype-aligned consensus supports endoscopic therapy for Hunner lesion (HL) disease and pelvic floor therapy for myofascial dysfunction, while cystoscopy timing, glycosaminoglycan therapy, neuromodulation, botulinum toxin, and central sensitization strategies vary. A phenotype-based framework comprising HLs, bladder-centric non-HLs, pelvic floor dysfunction, and systemic or central sensitization may harmonize divergent diagnosis and treatment guidelines.