Interstitial cystitis

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Also known as bladder pain syndrome[1] (IC, BPS) and Hunner's cystitis. The ulcerative form on cystoscopy is more often associated with Hunner.

Constellation of varied urinary symptoms. The European Society for the Study of Bladder Pain Syndrome/Interstitial Cystitis (ESSIC) have attempted to produce a consensus diagnostic criteria, but no single symptom is entirely sensitive or specific and much of the literature is based on inconsistent diagnostic features. It is best regarded as a diagnosis of exclusion.

Symptoms may include pain or discomfort attributed to the bladder along with urinary frequency and urgency. Sometimes probably associated with infection (but of organism impossible to easily grow with current techniques, such as nanobacteria), uncharacterised chemicals (including metabolic products and bacterial exotoxins), neurological damage or psychological illness. Afferent nerve hyperexcitability as a result of neurogenic bladder inflammation and urothelial dysfunction is a possible pathophysiological basis of the symptom development[2][3], but there is controversy and overlap with other difficult to diagnose and treat pain syndromes[4].

Symptoms include:

  • Urinary frequency (frequent urination)
  • Urinary urgency (sudden feeling of the need to immediately urinate)
  • Suprapubic discomfort or pressure on bladder filling, which fades away when urinating.

Similar conditions have been described in other mammals[5]

There are no pathognomonic histological features.[6]

The original description suggested mast cells had a predilection for the detrusor muscle,[7] but other papers suggest that certain sub-types show increased numbers in the submucosa instead.[8] Several papers have suggested using mast cell counts as an adjunct in histological assessment. However, methodology varies in terms of the thickness of microscopic sections (some use 10 microns vs 3-5 microns used in routine processing) and also detection method (metachromatic stains versus immunohistochemistry), such that it is difficult to compare data, e.g. counts of 20[9], 28[10] and >90/mm2[11] have been put forward. The ESSIC consensus documents suggests a mast cell counts of >28/mm2 using histochemical staining with naphtolesterase every third section from 24 10-µm sections. Given the variations in methodology, mast cells counts are not entirely sensitive or specific.

Epidemiology

  • Predominantly female (as with infective cystitis - UTI)
  • Genetic predisposition can exist

Treatment

Can be challenging since we are not dealing with one cause[12]

References

  1. van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M, Daha LK, Elneil S, Fall M, Hohlbrugger G, Irwin P, Mortensen S, van Ophoven A, Osborne JL, Peeker R, Richter B, Riedl C, Sairanen J, Tinzl M, Wyndaele JJ. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. European urology. 2008 Jan; 53(1):60-7.(Link to article – subscription may be required.)
  2. Vesela R, Aronsson P, Andersson M, Wsol V, Tobin G. The potential of non-adrenergic, non-cholinergic targets in the treatment of interstitial cystitis/painful bladder syndrome. Journal of physiology and pharmacology : an official journal of the Polish Physiological Society. 2012 Jun; 63(3):209-16.
  3. Bjorling DE, Wang ZY, Bushman W. Models of inflammation of the lower urinary tract. Neurourology and urodynamics. 2011 Jun; 30(5):673-82.(Link to article – subscription may be required.)
  4. Birder LA. Urinary bladder, cystitis and nerve/urothelial interactions. Autonomic neuroscience : basic & clinical. 2014 May; 182:89-94.(Link to article – subscription may be required.)
  5. Buffington CA. Idiopathic cystitis in domestic cats--beyond the lower urinary tract. Journal of veterinary internal medicine / American College of Veterinary Internal Medicine. 2011 Jul-Aug; 25(4):784-96.(Link to article – subscription may be required.)
  6. Lynes WL, Flynn SD, Shortliffe LD, Stamey TA. The histology of interstitial cystitis. The American journal of surgical pathology. 1990 Oct; 14(10):969-76.
  7. Larsen S, Thompson SA, Hald T, Barnard RJ, Gilpin CJ, Dixon JS, Gosling JA. Mast cells in interstitial cystitis. British journal of urology. 1982 Jun; 54(3):283-6.
  8. Feltis JT, Perez-Marrero R, Emerson LE. Increased mast cells of the bladder in suspected cases of interstitial cystitis: a possible disease marker. The Journal of urology. 1987 Jul; 138(1):42-3.
  9. Kastrup J, Hald T, Larsen S, Nielsen VG. Histamine content and mast cell count of detrusor muscle in patients with interstitial cystitis and other types of chronic cystitis. British journal of urology. 1983 Oct; 55(5):495-500.
  10. Larsen S, Thompson SA, Hald T, Barnard RJ, Gilpin CJ, Dixon JS, Gosling JA. Mast cells in interstitial cystitis. British journal of urology. 1982 Jun; 54(3):283-6.
  11. Johansson SL, Fall M. Clinical features and spectrum of light microscopic changes in interstitial cystitis. The Journal of urology. 1990 Jun; 143(6):1118-24.
  12. Dinis S, de Oliveira JT, Pinto R, Cruz F, Buffington CT, Dinis P. From bladder to systemic syndrome: concept and treatment evolution of interstitial cystitis. International journal of women's health. 2015; 7:735-44.(Epub) (Link to article – subscription may be required.)
  13. van Ophoven A, Pokupic S, Heinecke A, Hertle L. A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. The Journal of urology. 2004 Aug; 172(2):533-6.(Link to article – subscription may be required.)
  14. Thilagarajah R, Witherow RO, Walker MM. Oral cimetidine gives effective symptom relief in painful bladder disease: a prospective, randomized, double-blind placebo-controlled trial. BJU international. 2001 Feb; 87(3):207-12.
  15. Davis EL, El Khoudary SR, Talbott EO, Davis J, Regan LJ. Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. The Journal of urology. 2008 Jan; 179(1):177-85.(Link to article – subscription may be required.)
  16. Forrest JB, Payne CK, Erickson DR. Cyclosporine A for refractory interstitial cystitis/bladder pain syndrome: experience of 3 tertiary centers. The Journal of urology. 2012 Oct; 188(4):1186-91.(Link to article – subscription may be required.)
  17. Chen H, Wang F, Chen W, Ye Xt, Zhou Q, Shao F, Dai S, Yu Z, Zhang Y, Li C, Chen B, Weng Z. Efficacy of daily low-dose sildenafil for treating interstitial cystitis: results of a randomized, double-blind, placebo-controlled trial--treatment of interstitial cystitis/painful bladder syndrome with low-dose sildenafil. Urology. 2014 Jul; 84(1):51-6.(Link to article – subscription may be required.)
  18. Perez-Marrero R, Emerson LE, Feltis JT. A controlled study of dimethyl sulfoxide in interstitial cystitis. The Journal of urology. 1988 Jul; 140(1):36-9.
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