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Option (Evidence Strength: Grade C) Major Surgery Major surgery (e.g., substitution cystoplasty, urinary diversion with or without cystectomy) may be undertaken in carefully selected patients with bladder-centric symptoms, or in the rare instance when there is an end-stage small fibrotic bladder, for whom all other therapies have failed to provide adequate symptom control and quality of life improvement

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Aim for 0.8-1.2 grams per kilogram of body weight daily, with a minimum of 60 grams per day regardless of body weight

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But sometimes its taken as a supplement by those who are unable to produce sufficient glutamic acid on their own