Interstitial Cystitis

Question 1

What is interstitial cystitis?

Answer 1

Chronic condition causing inflammation in the bladder causing LUTS

Question 2

How does interstitial cystitis present?

Answer 2

Suprapubic pain
Worse with full bladder, relieved on emptying

Frequency

Urgency

Symptoms worsen during menstruation

Question 3

What investigations are used for interstitial cystitis?

Answer 3

Urinalysis- UTI
Swabs- STI
Cystoscopy- bladder cancer
Prostate exam- prostatitis, hypertrophy or cancer

Question 4

What are Hunner lesions?

Answer 4

Seen during cystoscopy 5-20% of the time in interstitial cystitis

Red inflamed patches of bladder mucosa associated with small blood vessels

Question 5

What is found on cystoscopy in patients with interstitial cystitis?

Answer 5

Hunner lesions

Granulations (tiny haemorrhages on bladder wall)

Question 6

How is interstitial cystitis managed?

Answer 6

Symptoms often resistant to treatment, significant impact on QoL

Supportive management
- Diet, avoid alcohol, caffeine and tomatoes
- Stop smoking
- Pelvic floor exercises
- Bladder retraining
- CBT
- Transcutaneous electrical nerve stimulation

Oral medications
- Analgesia
- Antihistamines
- Anticholinergics (solifenacin or oxybutynin)
- Mirabegron (B3 agonist)
- Cimetidine (H2 antagonist)
- Pentosan polysulphate sodium
- Ciclosporin (immunosuppressant)

Intravesical medication
- Lidocaine
- Pentosan polysulphate sodium
- Hyaluronic acid
- Chondroitin sulphate

Question 7

What is hydrodistension?

Answer 7

Filling bladder with water to high pressure during cystoscopy

Requires general anaesthetic

3-6 month symptom improvement

Question 8

What surgical procedures are used for interstitial cystitis?

Answer 8

• Cauterisation of Hunner lesions
• Botulinum toxin injections 300 units
• Neuromodulation
• Augmentation of bladder, using section of ileum to increase capacity
• Cystectomy