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In contrast, the following features indicate pain sources outside the bladder and a higher risk of failure: Large capacity under anesthesia Absence of Hunner lesions, Lack of relief with local anesthetic bladder instillations, Pelvic muscle tightness/tenderness, Genital hyperesthesia, Pain beyond the pelvis, such as the presence of widespread pain, and, most important, Polysymptomatic or polysyndromic presentation