Name
INTERSTITIAL CYSTITIS
DESCRIPTION
DETAIL
CAUSES . Unknown. Not primarily psychosomatic, though many secondary effects present . Possible causes: . Subclinical urinary infection . Increased bladder wall permeability to irritants such as urea . Autoimmune -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS • Uninhibited bladder (urgency, frequency, urge incontinence, less pain, symptoms usually decrease when asleep) • Urinary infection: Cystitis, prostatitis • Bladder neoplasm • Bladder stone • Neurologic bladder disease • Non-urinary pelvic disease (sexually transmitted diseases, endometriosis, pelvic relaxation)LABORATORY • Urinalysis: Normal except with chronic bacteriuria (rare) • Urine culture: Normal except with chronic bacteriuria (rare) • Urine cytology: Normal SPECIAL TESTS • Cystoscopy under anesthesia: Possible bladder ulcer • Bladder hydraulic distention: Cracking of mucosa after partial emptying with “watershed hemorrhage” • Bladder biopsies: Chronic inflammation
TYPENOTES
GENERAL MEASURES • Eliminate foods and liquids that exacerbate symptoms on individual basis • Biofeedback bladder retraining SURGICAL MEASURES • Hydraulic distention of bladder under anesthesia • Cauterization of bladder ulcer • Augmentation cystoplasty to increase bladder capacity and decrease pressure, with or without partial cystectomy. Expected results in severe cases: 75% much improved, 20% with residual discomfort, 5% unchanged. • Urinary diversion with total cystectomy DIET • Variable effects from person to person • Common irritants include caffeine, spicy foods, acidic foods, alcohol DRUG(S) OF CHOICE . Oxybutynin, hyoscyamine, and other anticholinergic medications decrease frequency . Doxepin decreases frequency . NSAIDs for pain and any infl ammatory component . Pentosan polysulfate (Elmiron) 100 mg three times daily. May take several months to become effective. . Triple drug therapy - 6 months of pentosan, hydroxyzine, doxepin . Antibacterials for bacteriuria . Bladder instillations: . DMSO every 1 to 2 weeks for 3 to 6 weeks, then as needed . Heparin sometimes added to DMSO . Other agents: steroids, lidocaine (Xylocaine), silver nitrate, oxychlorosene (Clorpactin) ALTERNATIVE DRUGS • Note that phenazopyridine, a local bladder mucosal anesthetic, is usually not very effective PATIENT MONITORING Not specifically needed unless symptoms unresponsive to treatment POSSIBLE COMPLICATIONS Type 3 with long term continuous high bladder pressure could be associated with renal damage EXPECTED COURSE/PROGNOSIS • Types 1 and 2: Exacerbations and remissions of symptoms. Generally not progressive. Does not predispose to other diseases. • Types 3 and 4: Progressive problems that usually require surgery to control symptoms
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
URINE ROUTINE, URINE CULTURE TEST, ULTRA SOUND K.U.B., COMPLETE BLOOD COUNT