Abstract
First described in 1887, interstitial cystitis is a bladder disorder of unknown etiology characterized by a constellation of irritative lower urinary tract symptoms including: dysuria, pelvic pressure or pain, urinary urgency, frequency, and a compulsion to constantly void, a sensation of incomplete bladder emptying, and associated sexual dysfunction.
Interstitial cystitis, which is also known as bladder pain syndrome, occurs nine times more frequently in women than in men and is characterized by exacerbations and remission with rare asymptomatic periods. The intensity of symptoms often varies from day to day and in females this waxing and waning may correlate with the patient’s ovulatory cycle. In men, complains of concomitant groin, perineal, penile, and scrotal pain. Patients suffering from interstitial cystitis often also suffer from irritable bowel syndrome, fibromyalgia, and focal vulvitis. Sleep disturbance is common as the symptoms of interstitial cystitis are often worse at night. The diagnosis of interstitial cystitis is often one of exclusion when no other demonstrable pathology can be found to account for the patient’s symptomatology.
Keywords
interstitial cystitis, Hunner ulcer, dysuria, pelvic pain, groin pain, irritable bowel syndrome, cystoscopy, drostadynia, orchalgia, urinary frequency
ICD-10 CODE N30.10
Keywords
interstitial cystitis, Hunner ulcer, dysuria, pelvic pain, groin pain, irritable bowel syndrome, cystoscopy, drostadynia, orchalgia, urinary frequency
ICD-10 CODE N30.10
The Clinical Syndrome
First described in 1887, interstitial cystitis is a bladder disorder of unknown etiology characterized by a constellation of irritative lower urinary tract symptoms including:
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Dysuria
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Pelvic pressure or pain
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Urinary urgency, frequency, and a compulsion to constantly void
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Sensation of incomplete bladder emptying
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Associated sexual dysfunction
Interstitial cystitis, which is also known as bladder pain syndrome, occurs nine times more frequently in women than in men and is characterized by exacerbations and remission with rare asymptomatic periods ( Fig. 94.1 ). The intensity of symptoms often varies from day to day, and in females this waxing and waning may correlate with the patient’s ovulatory cycle. In men, complaints of concomitant groin, perineal, penile, and scrotal pain are common. Patients suffering from interstitial cystitis often also suffer from irritable bowel syndrome, fibromyalgia, and focal vulvitis. Sleep disturbance is common as the symptoms of interstitial cystitis are often worse at night. The diagnosis of interstitial cystitis is often one of exclusion when no other demonstrable pathology can be found to account for the patient’s symptomatology.
Signs and Symptoms
Physical examination is often unrevealing in patients with interstitial cystitis. Careful bimanual pelvic examination, palpation of the full bladder, rectal examination, and neurologic examination are mandatory to identify other causes of lower urinary tract dysfunction. Examination of females suffering from interstitial cystitis may reveal increased pain on palpation of the urethra and the base of the bladder. In male patients, careful digital examination of the prostate is mandatory to rule out prostatitis and prostadynia, which may confuse the diagnosis. Anxiety may also be noted on physical examination.
Testing
Urinalysis is invariably normal in patients with interstitial cystitis as is urine cytology. Cystoscopy with hydrodistension of the bladder is indicated in all patients suspected of suffering from interstitial cystitis primarily to rule out other diseases that may account for the patient’s irritative bladder symptoms, as there are no pathognomonic cystoscopic findings associated with cystoscopy other than the Hunner ulcer. The Hunner ulcer occurs in approximately 5% of patients with interstitial cystitis. Also known as the Hunner lesion, the Hunner ulcer appears as a friable patch or ulcer of the bladder mucosa. Scarring may occur with small vessels radiating outward from the central lesion ( Fig. 94.2 ). Biopsy of the Hunner ulcer is mandatory to rule out occult malignancy including carcinoma in situ. Cystoscopic findings following bladder overdistention which are suggestive, but not diagnostic of interstitial cystitis, are small, petechial, raspberry-like hemorrhages within the bladder known as glomerulations ( Fig. 94.3 ). These glomerulations are invariably present in at least three quadrants of the bladder with sparing of the trigone. They are frequently distributed in a unique lattice or checkerboard appearance. It should be noted that glomerulations are also seen in patients suffering from bladder tumors, radiation cystitis, infection, chemical cystitis, and bladders that are chronically underfilled owing to renal failure or urinary diversion surgery ( Fig. 94.4 ).
