(U)- Interstitial Cystitis Flashcards
What is interstitial cystitis?
Chronic condition causing inflammation in the bladder causing LUTS
How does interstitial cystitis present?
Suprapubic pain
Worse with full bladder, relieved on emptying
Frequency
Urgency
Symptoms worsen during menstruation
What investigations are used for interstitial cystitis?
Urinalysis- UTI
Swabs- STI
Cystoscopy- bladder cancer
Prostate exam- prostatitis, hypertrophy or cancer
What are Hunner lesions?
Seen during cystoscopy 5-20% of the time in interstitial cystitis
Red inflamed patches of bladder mucosa associated with small blood vessels
What is found on cystoscopy in patients with interstitial cystitis?
Hunner lesions
Granulations (tiny haemorrhages on bladder wall)
How is interstitial cystitis managed?
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
What is hydrodistension?
Filling bladder with water to high pressure during cystoscopy
Requires general anaesthetic
3-6 month symptom improvement
What surgical procedures are used for interstitial cystitis?
- Cauterisation of Hunner lesions
- Botulinum toxin injections 300 units
- Neuromodulation
- Augmentation of bladder, using section of ileum to increase capacity
- Cystectomy