Cystoscopy and Hydrodistension in the Diagnosis of Bladder Pain Syndrome
Originally, interstitial cystitis was described as a particular, severe inflammation of the urinary bladder. When cystoscopes became available it was possible to diagnose the disease endoscopically, as described by Guy Hunner in his classic papers. More than a 100 years after the pioneering reports a new paradigm was launched and, while preserving the denomination IC, the concept was widened to include a larger population of subjects with bladder pain. With this approach cystoscopy was regarded as less important in the diagnostic workup. It has become evident, though, that the classic Hunner type of disease, the primary understanding of the diagnosis IC, stands out as a distinct entity. Examples of differences are that the results of various treatments and complication patterns, respectively, differ between phenotypes. The Hunner type of disease is more rewarding to treat, including excellent responses to ablative surgery, in bright contrast to other bladder pain syndrome (BPS) phenotypes. With this knowledge in mind it is not justifiable to do without confirmation or exclusion of this entity when evaluating chronic bladder pain. Cystoscopy and hydrodistension are still the means to make the differentiation. In this chapter, directions for how to carry out cystoscopy and hydrodistension in BPS are presented together with some typical examples of findings.
KeywordsCatheter Mast Cystitis Ooze Thiotepa
- 1.Skene AJC. Diseases of bladder and urethra in women. New York: Wm Wood; 1887. p. 167.Google Scholar
- 2.Hunner GL. Elusive ulcer of the bladder: further notes on a rare type of bladder ulcer with report of 25 cases. Am J Obstet. 1918;78:374–95.Google Scholar
- 7.Oravisto KJ. Epidemiology of interstitial cystitis. Ann Chir Gynaecol Finn. 1975;64:75–7.Google Scholar
- 11.Sant G, Meares EJ. Interstitial cystitis: pathogenesis, diagnosis, and treatment. Infect Urol. 1990;31:24–30.Google Scholar
- 18.Nigro D, Wein A. Interstitial cystitis: clinical and endoscopic features. In: Sant GR, editor. Interstitial cystitis. Philadelphia: Lippincott-Raven; 1997. p. 137–42.Google Scholar