Many urologists have their own experience in dealing with this type of disorder, but there are always a few patients who fail to solve the problem after repeated treatment. Interstitial cystitis (IC) is a treatable but incurable disease that is mainly characterized by frequent, urgent, nocturnal urination and chronic pelvic pain, and is easily overlooked by physicians in the clinical setting. The following is an introduction to the diagnosis and treatment of interstitial cystitis/bladder pain syndrome.
1, what is interstitial cystitis?
Interstitial cystitis is a lower urinary tract disease that includes severe pain in the bladder area during the storage and voiding periods, urinary urgency, frequency, painful urination, increased nocturia, along with a negative urine culture and other symptoms. In 1978 Walsh used the term “glomerulations” to describe them, meaning aggregates in small groups or glomeruloid changes.
The pathogenesis of interstitial cystitis is not yet clear and includes infectious factors, mast cell activation, neurogenic inflammation, altered bladder epithelial permeability, and autoimmune/inflammatory responses that may be associated with IC.
3, interstitial cystitis morbidity characteristics Prevalence age 30 C 70 years, 30 years accounted for 30%, the average age of diagnosis 42-46 years, female patients are 10 times more than male patients. Urinary frequency: frequent urination (can exceed 60 times/day). In early or mild patients, frequency of urination is sometimes the only symptom.
Urinary urgency: a sense of urgency to urinate, which may be accompanied by pain, bladder distention or cramping. Pain: may occur in the lower abdomen, urethra or vaginal area, painful intercourse. Men may experience pain in the testicles, scrotum and/or perineum, and painful ejaculation. Other symptoms: muscle and joint pain, periodic migraines, allergic reactions, and gastrointestinal symptoms. Many patients with IC have only bladder symptoms. There is relief of symptoms after the bladder is emptied.
4, Interstitial cystitis diagnostic criteria Patients with urinary frequency, urinary urgency, and pelvic pain should be considered for the presence of IC when other etiologies have been ruled out. 2003 US NIDDK US Department of Health Center for Kidney Research in the Diabetic Digestive System diagnostic criteria are: three symptoms: urinary frequency, urinary urgency, and pain, while ruling out other diseases. Pain is the predominant one, typically progressively worse with bladder filling and less painful with bladder emptying. After 80-100 cmH2O pressure bladder injection under anesthesia for 1-2 min, mucosal blebs were diffusely distributed and found in at least 3/4 quadrants of the bladder, with no less than 10 blebs per quadrant. Potassium permeation test is of value in the diagnosis of IC. Anesthetic hydrodilation + cystoscopy to detect mast cells is a recognized method for the diagnosis of IC.
5, treatment of interstitial cystitis Interstitial cystitis according to the International Continence Society (ICS) in 2005 and the 3rd International Consultation on Incontinence (ICI), According to the International Continence Society (ICS) and the 3rd International Consultation on Incontinence (ICI) in 2005, the treatment plan for IC includes first-line and second-line options. First-line options include dietary modification and behavior modification, medication (oral and intravenous), bladder infusion, and physical therapy; second-line options include botulinum toxin type A injections into the detrusor muscle, intravesical afferent nerve infusion (capsaicin), neuromodulation, and surgery.
There are so many treatment options that make this disease difficult to treat. This is a problem that both patients and doctors should understand, as there is no reliable treatment for IC. In fact, most patients benefit from a single treatment or a combination of treatments to achieve symptom relief, but the effectiveness and satisfaction of treatment varies from person to person, and symptom relief is mostly temporary and often requires repeated treatment. Among the various treatments for IC, behavioral therapy and pharmacotherapy should be the first line of treatment for IC, as they can improve symptoms in most patients. Bladder dilation is the most commonly used treatment modality and assists in the diagnosis and is recommended as the first-line treatment option. Oral medications, bladder irrigation, and bladder aqueous dilatation can be administered simultaneously, and the combination often provides better outcomes. Bladder wall injection of botulinum toxin type A is the only recommended second-line option, while all others are optional. Neuromodulation may be considered for patients with intractable IC who have failed to respond to oral medications and intravesical instillation. Surgical treatment is only an option after all conservative treatments have failed.
In summary, interstitial cystitis is not untreatable, and with the correct diagnosis and scientific treatment by a specialist, it should be said that this “difficult” disease can be controlled, at least to the desired state, by a specialist who can develop a reasonable individualized treatment based on the patient’s specific situation. This requires the joint efforts of highly qualified urologists and patients. Unfortunately, most urologists do not focus on this aspect of the disease, leaving many patients without good treatment. Hopefully, more urologists are paying attention to interstitial cystitis, especially female patients, who are more and more caring and medical care.