Interstitial cystitis

Question 1

What is interstitial cystitis?

Answer 1

A chronic condition causing inflammation in the bladder, resulting in LUTS and suprapubic pain

Question 2

What is the presentation of interstitial cystitis?

Answer 2

Suprapubic pain
Pain worse with full bladder and relieved with empty bladder
Frequency of urination
Urgency of urination
Symptoms may be worse during menstruation

Question 3

What investigations are used in the diagnosis of interstitial cystitis?

Answer 3

Urinalysis
Swabs for STIs
Cystoscopy
Prostate examination in men

Question 4

What are the findings on cystoscopy in patients with interstitial cystitis?

Answer 4

Hunner lesions
Granulations

Question 5

What are hunner lesions?

Answer 5

Red, inflamed patches of the bladder mucosa associated with small blood vessels

Question 6

What are granulations in interstitial cystitis?

Answer 6

Tiny haemorrhages of the bladder wall

Question 7

What is the first line management of interstitial cystitis?

Answer 7

Supportive management:
- Avoiding alcohol, caffeine and tomatoes
- Stopping smoking
- Pelvic floor exercises
- Bladder retraining
- CBT
- TENS

Question 8

What medications may be helpful in interstitial cystitis?

Answer 8

Analgesia
Antihistamines
Anticholingerics - solifenacin or oxybutynin
Mirabegron
Cimetidine

Question 9

What intravesical medication can be given for interstitial cystitis?

Answer 9

Lidocaine
Pentosan polysulfate sodium
Hyaluronic acid
Chondroitin sulfate

Question 10

What surgical procedures can be performed in the management of interstitial cystitis?

Answer 10

Cauterisation of hunner lesions
Botulinium toxin injections
Neuromodulation with implanted electrical nerve stimulator
Augmentation of the bladder
Cystectoym