Interstitial cystitis

Interstitial cystitis.  Illustration from the site www.neuro.jhmi.edu

What's this

Interstitial cystitis — is non-infectious inflammation of the bladder. Patients are irritative symptoms when urinating, which are caused by a decrease in bladder capacity and pain that arise when full (usually stoped when emptying the bladder) Urine bacterial flora and cytology negative for the disease is not detected any other urologic pathology .

Why did this happen

The cause of IC is unknown. Proposed many theories: the infectious, lymphatic congestion, neuropathy, failure of the protective layer of the bladder, psychological disorders, immunological disorders, exposure to toxic products contained in the urine. To date, none of these theories are not proven, and it is assumed that a predisposing factor is the lack of glycosaminoglycans covering the inner surface of the bladder. This allows components to be implemented in the normal urinary bladder wall and cause inflammation.

Who is affected

The majority of patients — women of reproductive age. Interstitial cystitis in women, at least 10 times more often than men and rarely diagnosed in children and the elderly. Patients for many years symptoms may be minimal, and then sets them to a sharp increase. Most of the time after a disease is stabilized. Many patients believe that they can continue to live with these symptoms after learning that they have cancer.

Diagnostics

Interstitial cystitis — is a diagnosis of exclusion. There is no absolute test to confirm diagnosis. If the patient has the urge to urinate, frequent urination, nocturia (night urge to urinate), pain in the suprapubic bladder fills, the corresponding cystoscopic picture with a negative culture and urine cytology, establish a presumptive diagnosis of interstitial cystitis.

How to perform a cystoscopy?

Cystoscopy is performed under anesthesia, and the conduct of the bladder distension fluid (gidrodistenziya). Gidrodistenziyu provide bladder filling liquid only under the action of gravity, while the receptacle has a 80-100 cm above the patient's bladder. Gidrodistenziya is both diagnostic and therapeutic method.

The most common initial symptom detectable at cystoscopy — a significant reduction in bladder capacity. However, it is not a diagnostic feature. Two features characteristic of interstitial cystitis are the so-called glomerulations Hanner and ulcers. Detecting these symptoms is diagnosed "interstitial cystitis. "

Shows whether a biopsy of the bladder?

Although controversial opinions that it is obvious that for confirmation interstitial cystitis perform a biopsy is not necessary. The main indication for biopsy is not confirmation of the diagnosis of interstitial cystitis, and the exclusion of carcinoma (cancer) of the urinary bladder. The decision to perform a biopsy should be based on the assumption of a urologist about a possible malignant process.

Treatment

It is important to confirm the diagnosis before starting any treatment.

Therapeutic measures range from medication to surgery. They may be local or systemic. Typically, the primary treatment — is gidrodistenziya, because it is part of the diagnostic test. Gidrodistenziya achieves improvement in approximately 50-60% of patients.

The next step consists of successive treatment of the various infusion preparations in uric bubble.Systemic therapy is also used PPS, amitriptyline and heparin. In addition, there are non-drug treatments such as biofeedback and exercise bladder.

In the most severe cases may be indicated surgery. The methods varied, from dissection of the bladder with the intersection of nerve fibers, vascular perfusion augmentation and orthotopic bladder creation (increasing bladder capacity due to the segment of the intestine) to complete diversion.

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