What are the clinical and pathologic features needed for the diagnosis of interstitial cystitis? What are the most important entities that should be considered in the differential diagnosis?


Although called “cystitis” for years, interstitial cystitis currently is regarded as a painful bladder syndrome because it does not always demonstrate an inflammatory picture microscopically. It is an enigmatic condition of unknown etiology and pathogenesis. The diagnosis is established based on clinical features, which consist of irritative voiding symptoms including urgency, frequency, pain, and absence of objective evidence of other disease (including negative urine culture and cytology) as well as characteristic endoscopic findings, which generally are demonstrated after overdistension of the bladder. Because the presenting symptoms of interstitial cystitis are suggestive of an inflammatory process, infectious disease, or a urothelial neoplasm, especially carcinoma in situ must be excluded by urine culture and microscopic examination of urine sediment/biopsy specimens. The etiology and pathogenesis and therapy are discussed under Questions 6 and 7, respectively.


Mast Cell Lamina Propria Interstitial Cystitis Detrusor Muscle Urethral Diverticulum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hunner GL (1918) A rare type of bladder ulcer in women; report of cases. Boston Med Surg J 172: 660–668.Google Scholar
  2. 2.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) The standardization of terminology of lower urinary tract function: report from Standardization Sub-Committee of the International Continence Society. Neurourol Urodyn 21: 167–178.PubMedCrossRefGoogle Scholar
  3. 3.
    Warren JW, Meyer WA, Greenberg P, Horne L, Diggs C, Tracy JK (2006) Using the International Continence Society’s definition of painful bladder syndrome. Urology 67: 1138–1143.PubMedCrossRefGoogle Scholar
  4. 4.
    Clemens JQ, Meenan RT, Rosetti MC, Gao SY, Calhoun EA (2005) Prevalence and incidence of interstitial cystitis in a managed care population. J Urol 173: 98–102.PubMedGoogle Scholar
  5. 5.
    Simon LJ, Landis J, Erickson DR, Nyberg LM, the ICDB Study Group (1997) The Interstitial Cystitis Database Study: concepts and preliminary baseline descriptive statistics. Urology 49(suppl 5A): 64–75.PubMedCrossRefGoogle Scholar
  6. 6.
    Ito T, Miki M, Yamada T (2000) Interstitial cystitis in Japan. BJU Int 86: 634–637.PubMedCrossRefGoogle Scholar
  7. 7.
    Kusek JW, Nyberg LM (2001) The epidemiology of interstitial cystitis: is it time to expand our definition? Urology 57(suppl 6A): 95–99.PubMedCrossRefGoogle Scholar
  8. 8.
    Ueda T (2003) The legendary beginning of the international consultation on interstitial cystitis. Intern J Urol 10: S1–S2.CrossRefGoogle Scholar
  9. 9.
    Hanno PM (1998) Interstitial cystitis and related diseases. In: Walsh PC, Retic AD, Vaughn ED Jr, Wein AJ (eds) Campbell’s urology, vol 1. Saunders, Philadelphia, pp 631–662.Google Scholar
  10. 10.
    Peeker R, Fall M (2002) Toward a precise definition of interstitial cystitis: further evidence in differences of classic and nonulcer disease. J Urol 167: 2470–2472.PubMedCrossRefGoogle Scholar
  11. 11.
    Buffington CA (2004) Comorbidity of interstitial cystitis with other unexplained clinical conditions. J Urol 172: 1242–1248.PubMedCrossRefGoogle Scholar
  12. 12.
    Erickson DR, Belchis DA, Dabbs DJ (1997) Inflammatory cell types and clinical features of interstitial cystitis. J Urol 158: 790–793.PubMedCrossRefGoogle Scholar
  13. 13.
    Keller ML, McCarthy DO, Neider RS (1994) Measurement of symptoms of interstitial cystitis: a pilot study. Urol Clin North Am 21: 67–71.PubMedGoogle Scholar
  14. 14.
    Erickson DR, Morgan KC, Ordille S, Keay SK, Xie SX (2001) Nonbladder related symptoms in patients with interstitial cystitis. J Urol 166: 557–562.PubMedCrossRefGoogle Scholar
  15. 15.
    Goin JE, Olaleye D, Peters KM, Steinert B, Habicht K, Wynant G (1998) Psychometric analysis of the University of Wisconsin interstitial cystitis scale: implications for use in randomized clinical trials. J Urol 159: 1085–1090.PubMedCrossRefGoogle Scholar
  16. 16.
    O’leary MP, Sant GR, Fowler FJ Jr, Whitmore KE, Spolarich-Kroll J (1997) The interstitial cystitis symptom index and problem index. Urology 49(suppl 5A): 58–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Gillenwater JY, Wein AJ (1988) Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28–29, 1987. J Urol 140: 203–206.PubMedGoogle Scholar
  18. 18.
    Wein AJ, Hanno PM, Gillenwater JY (1990) Interstitial cystitis: an introduction to the problem. In: Hanno PM, Staskin DR, Krane RJ, Wein AJ (eds) Interstitial cystitis. Springer-Verlag, London, pp 3–15.Google Scholar
  19. 19.
    Hanno PM (1994) Diagnosis of interstitial cystitis. Urol Clin North Am 21: 63–66.PubMedGoogle Scholar
  20. 20.
    Hanno PM, Landis JR, Matthews-Cook Y, Kusek J, Nyberg L Jr, The Interstitial Database Study Group (1999) The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database Study. J Urol 161: 553–557.Google Scholar
  21. 21.
    Nickel JC (2004) Interstitial cystitis: the paradigm shifts. International consultations on interstitial cystitis. Rev Urol 6: 200–202.PubMedGoogle Scholar
  22. 22.
    Waxman JA, Sulak PJ, Kuehl TJ (1998) Cystoscopic findings consistent with interstitial cystitis in normal women undergoing tubal ligation, J Urol 160: 1663–1667.PubMedCrossRefGoogle Scholar
  23. 23.
    Denson MA, Griebling TL, Cohen MB, Kreder KJ (2000) Comparison of cystoscopic and histological findings in patients with suspected interstitial cystitis. J Urol 164: 1908–1911.PubMedCrossRefGoogle Scholar
  24. 24.
    Tomaszewski JE, Landis JR, Russack V, Williams TM, Wang L-P, Hardy C, Brensinger C, Matthews YL, Abele ST, Kusek JW, Nyberg LM; The Interstitial Cystitis Database Study Group (2001) Biopsy features are associated with primary symptoms in interstitial cystitis: results from the interstitial cystitis database study. Urology 57(suppl 6A): 67–81.PubMedCrossRefGoogle Scholar
  25. 25.
    Ottem DP, Teichman JM (2005) What is the value of cystoscopy with hydrodistention for interstitial cystitis? Urology 66: 494–499.PubMedCrossRefGoogle Scholar
  26. 26.
    Simon LJ, Landis JR, Erickson DR, Nyberg LM, the ICDB Study Group (1997) The Interstitial Cystitis Data Base Study: concepts and preliminary baseline descriptive statistics. Urology 49(suppl 5A): 64–75.PubMedCrossRefGoogle Scholar
  27. 27.
    Messing EM, Stamey TA (1978) Interstitial cystitis: early diagnosis, pathology, and treatment. Urology 12: 381–392.PubMedCrossRefGoogle Scholar
  28. 28.
    Hand JR (1949) Interstitial cystitis: report of 223 cases (204 women and 19 men). J Urol 61: 291–310.PubMedGoogle Scholar
  29. 29.
    Johansson SL, Fall M (1990) Clinical features and spectrum of light microscopic changes in interstitial cystitis. J Urol 143: 1118–1124.PubMedGoogle Scholar
  30. 30.
    Walsh A (1978) Interstitial cystitis. In: Harrison JH, Gittes RF, Perlmutter AD, et al (eds) Campbell’s urology, vol 1. Saunders, Philadelphia, pp 693–707.Google Scholar
  31. 31.
    Fall M, Johansson SL, Aldenborg F (1987) Chronic interstitial cystitis; a heterogeneous syndrome. J Urol 137: 35–38.PubMedGoogle Scholar
  32. 32.
    Johansson SL, Fall M, Peeker R (2004) Interstitial cystitis. In: Foster CS, Ross JS (eds) Pathology of the urinary bladder. Saunders, Philadelphia, pp 91–101.Google Scholar
  33. 33.
    Theoharides TC, Sant GR, El-Mansoury M, Letourneau R, Ucci AA Jr, Meares EM Jr (1995) Activation of bladder mast cells in interstitial cystitis: a light and electron microscopic study. J Urol 153: 629–636.PubMedCrossRefGoogle Scholar
  34. 34.
    Pang X, Marchand J, Sant GR, Kream RM, Theoharides TC (1995) Increased number of substance P positive nerve fibers in interstitial cystitis. Br J Urol 75: 744–750.PubMedCrossRefGoogle Scholar
  35. 35.
    Larsen S, Thompson SA, Hald T, Barnard RJ, Gilpin CJ, Dixon JS, Gosling JA (1982) Mast cells in interstitial cystitis. Br J Urol 54: 283–286.PubMedCrossRefGoogle Scholar
  36. 36.
    Kastrup J, Hald T, Larsen S, Nielsen VG (1983) Histamine content and mast cell count of detrusor muscle in patients with interstitial cystitis and other types of chronic cystitis. Br J Urol 55: 495–500.PubMedCrossRefGoogle Scholar
  37. 37.
    Lynes WL, Flynn SD, Shortliffe LD, Lemmers M, Zipser R, Roberts J II, Stamey TA (1987) Mast cell involvement in interstitial cystitis. J Urol 138: 746–752.PubMedGoogle Scholar
  38. 38.
    Christmas TJ, Rode J (1991) Characteristics of mast cells in normal bladder, bacterial cystitis and interstitial cystitis. Br J Urol 68: 473–478.PubMedCrossRefGoogle Scholar
  39. 39.
    Feltis JT, Perez-Marrero R, Emerson LE (1987) Increased mast cells of the bladder in suspected cases of interstitial cystitis: a possible disease marker. J Urol 138: 42–43.PubMedGoogle Scholar
  40. 40.
    Aldenborg F, Fall M, Enerback L (1986) Proliferation and transepithelial migration of mucosal mast cells in interstitial cystitis. Immunology 58: 411–416.PubMedGoogle Scholar
  41. 41.
    Lundeberg T, Liedberg H, Nordling L, Theodorsson E, Owzarski A, Ekman P (1993) Interstitial cystitis: correlation with nerve fibers, mast cells and histamine. Br J Urol 71: 427–429.PubMedCrossRefGoogle Scholar
  42. 42.
    Dundore PA, Schwartz AM, Semerjian H (1996) Mast cell counts are not useful in the diagnosis of nonulcerative interstitial cystitis. J Urol 155: 885–887.PubMedCrossRefGoogle Scholar
  43. 43.
    Wingren U, Enerback L (1983) Mucosal mast cells of the rat intestine: a re-evaluation of fixation and staining properties, with special reference to protein blocking and solubility of the granular glycosaminoglycan. Histochem J 15: 571–582.PubMedCrossRefGoogle Scholar
  44. 44.
    Enerback L (1966) Mast cells in rat gastrointestinal mucosa. I. Effect of fixation. Acta Pathol Microbiol Scand 66: 289–302.PubMedGoogle Scholar
  45. 45.
    Galli SJ (1993) New concepts about the mast cells. N Engl J Med 328: 257–265.PubMedCrossRefGoogle Scholar
  46. 46.
    Letourneau R, Pang X, Sant GR, Theoharides TC (1996) Intragranular activation of bladder mast cells and their association with nerve processes in interstitial cystitis. Br J Urol 77: 41–54.PubMedGoogle Scholar
  47. 47.
    Yun SK, Laub DJ, Weese DL, Lad PM, Leach GE, Zimmern PE (1992) Stimulated release of urine histamine in interstitial cystitis. J Urol 148: 1145–1148.PubMedGoogle Scholar
  48. 48.
    Pang X, Boucher W, Triadafilopoulos G, Sant GR, Theoharides TC (1996) Mast cell and substance P-positive nerve involvement in a patient with both irritable bowel syndrome and interstitial cystitis. Urology 47: 436–438.PubMedCrossRefGoogle Scholar
  49. 49.
    Elbadawi AE, Light JK (1996) Distinctive ultrastructural pathology of nonulcerative interstitial cystitis: new observations and their potential significance in pathogenesis. Urol Int 56: 137–162.PubMedCrossRefGoogle Scholar
  50. 50.
    Elbadawi A (1997) Interstitial cystitis: a critique of current concepts with a new proposal for pathologic diagnosis and pathogenesis. Urology 49(suppl 5A): 14–40.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Personalised recommendations