What is Interstitial Cystitis?

Interstitial cystitis (IC) often occurs in middle-aged women and is characterized by fibrosis of the bladder wall. It is accompanied by a decrease in bladder capacity, with frequent urination (usually every 10 minutes), urgency, pressure or tenderness in the bladder or pelvic area as the main symptoms.

Basic Information

English name: interstitial cystitis
Visiting department: Urology

Multiple groups: Middle-aged women
Common locations: bladder
Common symptoms: Frequent urination, urgency, increased nocturia, etc.

Causes of interstitial cystitis

Patients' urine was normal, and infection was not the main cause of bladder wall fibrosis. Some scholars believe that lymphatic obstruction caused by pelvic surgery or infection is the cause, and many patients do not have such a history. Some scholars have suggested that it is caused by thrombophlebitis with acute infection of the bladder or pelvic organs, or caused by long-term spasm of small arteries caused by mental impulses, and may also be related to endocrine factors. At present, there is a lot of evidence that interstitial cystitis is an autoimmune collagen disease. Attention has been paid to the role of mast cells and bladder surface amino acid glycosides in interstitial cystitis, and some researchers are working on this.

Clinical manifestations of interstitial cystitis

Patients often have long-term progressive frequent urination, urgency, and nocturia, and pain in the upper pubic area is obvious when the bladder is full, and sometimes urethral and perineal pain can also occur, which can be relieved after urination. Hematuria can occur and overfill the bladder Filling expansion is obvious, and some patients may have allergic disorders in their medical history.

Interstitial cystitis examination

Clinical examination

Generally normal, some patients may experience tenderness in the upper part of the pubic bone, and in female patients, there may be tenderness in the bladder area when palpating the anterior wall of the vagina.

2. Laboratory inspection

Most of the patients' urine routine is normal, hematuria may occur, and there is no bacterial growth in urine culture. The renal function test will not change unless the bladder fibrosis causes bladder ureteral reflux or obstruction.

3. Radiological examination

Excretory urography is generally no abnormality. When combined with reflux, the hydronephrosis and decreased bladder capacity can be seen on the film. Cystography shows diminished bladder volume, and bladder ureteral reflux is sometimes found.

4. Cystoscopy

It is an important method for the diagnosis of interstitial cystitis. In some patients, the bladder volume can be reduced to 50 to 60 ml. Due to the diminished bladder volume, the patient is very distressed. Liquid bladder expansion is required under anesthesia. Small patchy smuts, bleeding, and scars, fissures or infiltration can be seen on top of the bladder blood. Hunner's ulcer was found to help confirm the diagnosis, but most patients have no ulcers. The untreated bladder mucosa has a normal appearance or only chronic inflammation changes. Sometimes small bleeding points are visible on the top. If the bladder continues to overfill, it can cause mucosa. Rupture and bleeding, submucosal vascular pellets are visible, often unevenly distributed throughout the bladder, and biopsies are performed at the same time.

5.Urodynamic tests

Urodynamic examination can find that the bladder has small volume and poor compliance, but does not show uninhibited contraction. This test helps distinguish interstitial cystitis from unstable bladder or neurogenic bladder.

Interstitial cystitis diagnosis

Patients are more common in young women and have more sexual partners. Drinking women are susceptible to this syndrome, plus the above clinical manifestations should consider the existence of this syndrome. Cystoscopy under anesthesia can make a diagnosis of interstitial cystitis. The appearance and volume of the bladder are normal at first, but after the bladder is filled and emptied, and then filled again, scattered submucosal hemorrhage biopsies can often be seen. The above-mentioned epidermal layer shows pathological changes of edema, congestion, telangiectasia, and interstitial hemorrhage around the blood vessels. It can also be used to exclude some carcinoma in situ and tuberculosis. Local vulvitis had small erythematous lesions on the lateral hymen of the hymen, and the rest were normal.

Differential diagnosis of interstitial cystitis

Acute cystitis also manifests as bladder irritation such as frequent urination, urgency, and dysuria. However, there is often terminal hematuria, and there are a large number of white blood cells in the urine, and bacteria can be found in urine culture. Glandular cystitis also manifests as bladder irritation such as frequent urination, urgency, and dysuria. However, B-ultrasound can detect thickening of the bladder wall or occupying lesions in the bladder. Nipples can be seen on the cystoscope instead of superficial ulcers. A biopsy can confirm the diagnosis. Bladder tuberculosis can also be manifested as a true ulcer, often involving the ureteral orifice of the renal side of tuberculosis, and pyuria can appear. Urine examination can find tuberculosis bacillus, and urography can show typical changes in renal tuberculosis. The bladder ulcer caused by parasitic disease is similar to interstitial cystitis. It is common in men. Diagnosis can be made according to the worm eggs found in the urine or the typical bladder pathological features. Non-specific cystitis has few bladder ulcers, pus cells and infections are common in urine, and antibiotic treatment is effective.

Interstitial cystitis complications

Interstitial cystitis in the late stage of bladder contracture or ureteral reflux, ureteral stenosis, can cause hydronephrosis or pyelonephritis, and even renal failure.

Interstitial cystitis treatment

General treatment, bladder sac dilatation, acupuncture and surgical treatment are used. Its efficacy varies.

Non-surgical method

Drug treatment mainly includes oral drugs and bladder drug infusion. At present, non-surgical methods are mainly used to relieve symptoms and improve quality of life, such as bladder water pressure expansion, oral drugs, bladder drug perfusion, and nerve stimulation. Not every treatment is suitable for all patients.

Drug treatment, including immunosuppressive drugs, antihistamines, heparin, pentosan sulfate, etc. Bladder infusion drugs include silver nitrate, 50% dimethyl sulfoxide (dimethyl sulfoxide), and BCG. Injecting hydrocortisone or heparin around the ulcer through cystoscopy can enlarge the bladder capacity and relieve symptoms.

2. Surgical treatment

When non-surgical treatment is not effective, surgical treatment can be considered. Transurethral resection is suitable for ulcerative interstitial cystitis. The recent results are good, but it is easy to relapse. However, the cystectomy and total cystectomy should be carefully selected . In view of the diversity and complexity of the etiology of this disease, the effect of comprehensive treatment and combined medication may be better.