| disease | Interstitial Cystitis |
Interstitial cystitis commonly occurs in middle-aged women, characterized primarily by fibrosis of the bladder wall. It is accompanied by a reduction in bladder capacity, with frequent urination, urgency, and distending pain in the bladder area as its main symptoms.
bubble_chart Etiology
The patient's urine is normal, and infection is not the main disease cause of bladder wall fibrosis. Some scholars believe that pelvic surgery or infection-induced lymphatic obstruction is the disease cause, yet many patients do not have such a medical history. Other scholars suggest that it may be due to thrombophlebitis accompanied by acute infection of the bladder or pelvic organs, or long-term spasms caused by mental impulses, and it may also be related to endocrine factors.
Currently, a large body of evidence suggests that interstitial cystitis is an autoimmune collagen disease. Oravisto et al. studied 54 female patients with this disease and found that 85% of the patients had antinuclear antibodies, and a significant number of patients had reagin-type allergic reactions or hypersensitivity to drugs. This can be explained by the high sensitivity to adrenal cortical hormone treatment. Currently, attention is being paid to the role of mast cells and bladder surface amino acid glycosides in interstitial cystitis, and some researchers are conducting studies in this area.
bubble_chart Pathological Changes
Pathological findings reveal deep fibrosis of the bladder wall, leading to a reduction in its capacity, sometimes significantly. The bladder mucosa becomes thinner, most notably in areas of maximum bladder contraction and relaxation, and small ulcers or fissures may also be observed. In some severe cases, damage to the bladder-ureter junction can cause vesicoureteral reflux, and even lead to hydroureter and pyelonephritis. Microscopically, the bladder mucosa is thinned or even denuded, with capillary congestion and inflammatory reactions present in the lamina propria. There is significant fibrous tissue proliferation in the muscle layer, with dilated lymphatics, and infiltration of lymphocytes and mast cells.
bubble_chart Clinical ManifestationsFor middle-aged women presenting with severe urinary frequency, urgency, and increased nocturia accompanied by distending pain in the suprapubic bladder area but with normal urine tests, interstitial cystitis should be considered.
(1) Symptoms: Patients often have long-term progressive urinary frequency, urgency, and increased nocturia. Pain in the suprapubic area is significant when the bladder is full, and sometimes pain in the urethra and perineum may also occur, which is relieved after urination. Hematuria may occasionally appear, especially when the bladder is overfilled and distended. Some patients may have a history of allergic diseases.
(2) Signs: Clinical examinations are generally normal. Some patients may exhibit tenderness in the suprapubic area, and in female patients, tenderness in the bladder area may be felt during palpation of the anterior vaginal wall.
(3) Laboratory tests: Most patients have normal urine routine tests, but hematuria may be present. Renal function tests usually remain normal unless bladder fibrosis leads to vesicoureteral reflux or obstruction.
(4) Radiological examination: Excretory urography is generally normal. In cases with reflux, hydronephrosis and reduced bladder capacity may be seen on the imaging.
(5) Instrumental examination: Cystoscopy is an important method for diagnosing interstitial cystitis. Due to reduced bladder capacity, patients may experience significant discomfort. After liquid bladder distension, small patchy ecchymosis, bleeding, scars, fissures, or oozing blood may be observed at the top of the bladder.
bubble_chart Treatment Measures
(1) Special Treatment: There is no specific treatment for interstitial cystitis. Antagonism may spontaneously resolve, and through treatment, some symptoms may be alleviated, while others may remain ineffective.
Stewat et al. (1976) reported that injecting 50ml of 50% dimethyl sulfoxide into the bladder twice a week, retaining it for 15 minutes each time, achieved good results. Fowler et al. (1981) reported similar therapeutic effects. Messing et al. reported that under anesthesia, intravesical instillation of 0.4% oxychlorosene sodium, with the bladder repeatedly and fully dilated under 10cm water pressure using 1000ml of solution, can also achieve good results. It must be noted that this method is contraindicated in patients with vesicoureteral reflux to avoid ureteral fibrosis.
Parsons et al. (1983) found that the bladder mucosa of patients who did not respond to bladder dilation therapy or intravesical dimethyl sulfoxide instillation lacked a layer of sulfated amino acid polysaccharides. Since sulfated amino acid polysaccharides protect bladder transitional cells from erosion by irritants in urine, patients were given oral SP-54 (sodium pentosan polysulfate) four times a day, 50mg each time, or twice a day, 100mg each time, for 4 to 8 weeks. Among the 24 treated patients, 20 (80%) experienced symptom relief, 2 had 50-80% relief, and the other 2 were ineffective.
Oral administration of 100mg of hydrocortisone acetate or 10-20mg of prednisone daily, reducing the dose after 3 weeks and continuing for another 3 weeks, can also be effective. Some advocate for local injection of prednisone via cystoscope.
For patients who do not respond to the above treatments, surgical treatment may be considered. For example, in cases of severe bladder fibrosis with very little capacity, the bladder can be enlarged using the cecum or ileum without performing urinary diversion, achieving better results.
(2) General Treatment: Systemic or local sedatives can be used, but the efficacy is poor. If combined with urinary tract infection, appropriate antibiotic treatment can be used. For senile urethritis, estradiol vaginal suppositories can be chosen.
(3) Treatment of Complications: For progressive hydronephrosis caused by ureteral stricture, if ureteral dilation methods are ineffective, ureteroileal cutaneous ureterostomy may be necessary.
Most patients with interstitial cystitis can achieve results through conservative treatment; if ineffective, surgical treatment is necessary.
It may be accompanied by progressive ureteral stenosis, reflux, and the subsequent development of hydronephrosis.
Bladder subcutaneous nodes can also manifest as true ulcers, often involving the area around the ureteral orifice on the renal side of the subcutaneous node. Pyuria may be present, and subcutaneous node bacilli can be found in urine tests. Urography can reveal typical changes of renal subcutaneous nodes. Bladder ulcers caused by Chinese Taxillus Herb parasite infection resemble the manifestations of interstitial cystitis, generally more common in males. Diagnosis can be made based on the presence of parasite eggs in urine or typical bladder pathological features. Non-specific cystitis rarely presents with bladder ulcers, and pyocytes and infectious bacteria are commonly found in urine, with antibiotic treatment being very effective.
Utz and Zinke (1974) found that 20% of the interstitial cystitis cases they diagnosed in males were actually cancerous, thus emphasizing the necessity of biopsy cytology examination.
