Interstitial cystitis often occurs in middle-aged women and is characterized mainly by fibrosis of the bladder wall. It is accompanied by a reduction in bladder volume, with frequency, urgency, and distension of the bladder area as its main symptoms.
Etiology
Infection is not the main cause of bladder wall fibrosis, but lymphatic obstruction from pelvic surgery or infection has been suggested as the cause, while many patients do not have such a history. It has also been proposed that it is due to thrombophlebitis with acute infection of the bladder or intrapelvic organs, or due to mental impulses producing prolonged spasm of small arteries, and may also be related to endocrine factors.
Currently, a large body of evidence suggests that interstitial cystitis is an autoimmune collagenous disease. oravisto et al. studied 54 female patients with this disease and found antinuclear antibodies in 85% of patients and a significant number of patients had allergic reactions of the reactin type or hypersensitivity to drugs. This can be explained by hypersensitivity to adrenocorticosteroid therapy. Attention is currently being paid to the role of mast cells and bladder surface amino acid glycosides in interstitial cystitis, and several researchers are working on this.
Diagnostic approach
Patients are predominantly young women with a high number of sexual partners, and the presence of this syndrome should be considered in conjunction with the above clinical presentation in women who drink alcohol.
The diagnosis of interstitial cystitis can be made by cystoscopy performed under anesthesia. The appearance and volume of the bladder is normal at the beginning of the procedure, but after the bladder is filled and emptied and then refilled, scattered submucosal hemorrhages can often be seen. Biopsy can show the above pathological changes of edema, congestion, capillary dilatation and perivascular interstitial hemorrhage in the subepithelial layer. Restricted vulvodynia has small erythematous lesions on the lateral vestibule of the hymen and the rest is normal. The pH of the vagina is measured and a 10% potassium hydroxide solution is added to the vaginal discharge without a fishy odor. Microscopic examination of the suspension of the discharge reveals no cells suggestive of a diagnosis and the discharge is negative for Chlamydia trachomatis, gonococcus and Trichomonas vaginalis.
Pathological changes
Pathologic findings include deep fibrosis of the bladder wall, which reduces its volume, sometimes quite significantly. The bladder mucosa thins, which is most evident at the site of maximal bladder stretching, and sometimes small ulcers or fissures can be seen. In some severe cases, damage to the vesicoureteral junction can produce vesicoureteral reflux and even ureteral hydronephrosis and pyelonephritis. Microscopically, the bladder mucosa becomes thin and even exfoliates, capillaries in the lamina propria are often congested with an inflammatory response, fibrous tissue proliferation is evident in the muscularis and lymphatic vessels are dilated. There is also lymphocytic infiltration and mast cell infiltration.
Clinical manifestations
Interstitial cystitis should be thought of in middle-aged women who present with severe urinary frequency, urgency and increased nocturia with distension and pain in the suprapubic bladder area while urinalysis is normal.
(1) Symptoms: Patients often have long-term progressive urinary frequency, urinary urgency and nocturia, pain in the suprapubic area during bladder filling, sometimes pain in the urethra and perineum, which is relieved after urination, hematuria may occasionally occur, which is obvious when the bladder is overfilled and dilated, and some patients may have allergic disorders in their medical history.
(2) Signs: Clinical examination is generally normal, some patients may have tenderness in the upper pubic bone, and in female patients there may be tenderness in the bladder area during palpation of the anterior vaginal wall.
(3) Laboratory tests: most of the patients have normal urine routine, hematuria may be present, and renal function tests may change except in cases of bladder fibrosis leading to vesicoureteral reflux or obstruction.
(4) Radiological examination: excretory urography is usually not abnormal. In case of combined reflux, hydronephrosis and reduced bladder capacity are seen on the imaging film.
(5) Instrumentation: cystoscopy is an important method for the diagnosis of interstitial cystitis, which is very painful for the patient because of the reduced bladder capacity.
Complications
Progressive ureteral stenosis, reflux, and subsequent development of hydronephrosis can be complicated.
Differential diagnosis
Tuberculosis of the bladder may also present as a true ulcer, often involving the ureteral orifice around the side of the tuberculous kidney, and may present with pus urine. Bladder ulcers caused by parasitic diseases resemble the manifestations of interstitial cystitis, which is usually more frequent in men, and the diagnosis can be made based on finding eggs in the urine or typical bladder pathological features. In contrast, non-specific cystitis rarely presents with bladder ulcers, pus cells and infectious bacteria are common in the urine, and antibiotic therapy is very effective.
Treatment options
General treatment, bladder bladder dilatation, acupuncture and surgery are used. Their efficacy varies. Currently. Drug therapy is gradually emerging, mainly with oral drugs and bladder drug infusion. The current treatment mainly uses non-surgical methods to relieve symptoms and improve the quality of life, such as bladder hydrodilation, oral medications, bladder drug instillation, and nerve stimulation. And each treatment method is not suitable for all patients. When non-surgical treatment is ineffective, surgical treatment can be considered. Transurethral electrodesiccation is suitable for ulcerative IC with good recent results, but is prone to recurrence, while bladder enlargement and total bladder dissection are highly invasive and should be chosen carefully. In view of the diversity and complexity of the etiology of IC, the effect of comprehensive treatment and combined medication may be better. Combining the above reasons, several non-surgical therapies were selected to cooperate with the treatment in this group of cases. Altered epithelial permeability is the cause and possible mechanism of IC inflammation and pain symptoms, and heparin has a protective effect on the bladder GAGs layer, thus relieving symptoms. Recent studies have shown that intravesical infusion of dimethyl sulfoxide and heparin can inhibit the release of intracellular ATP to extracellular in bladder tissue and also block the activation of sensory nerve receptors (e.g., P2X3) by ATP to achieve pain relief, and the effect of heparin is stronger than that of dimethyl sulfoxide [6]. In this group of cases, two cases were also treated with the synergistic use of both, with no significant side effects, no serious complications, good tolerability, and longer maintenance of efficacy. It is suggested that dimethyl sulfoxide with heparin bladder perfusion can be used as a method of IC treatment. Antibiotic therapy is preferred in Western medicine. Such as sulfamethoxazole (SMZ) 2.0g methotrexate (TMP) 0.4g , sodium bicarbonate 1.0g, once a dose; or compound Xinomin 5 tablets or hydroxybenzyl penicillin 3.0g, or methotrexate 4 00mg dose, although the Western medicine effect is fast, but after all, chemical drugs on will be the human body produces toxic side effects, more likely to produce drug resistance, easy to repeat. In contrast, the modern Chinese medicine treatment of interstitial cystitis is more effective and scientific.
The treatment of Chinese medicine should be based on clearing heat and detoxifying the toxin, dampness and laxative, supplemented by tonifying the kidneys and consolidating the root, activating blood circulation and eliminating blood stasis, supporting the righteousness and eliminating evil, and improving the immunity of the body as the method of formula. It can effectively treat chronic pyelonephritis; chronic pyelonephritis chronic attacks; cystitis; chronic cystitis and other urinary tract infections. It is effective in the treatment of frequent urination, slow urination, astringent painful urination, short red urination, dripping urination, red and yellow urination, lumbar pain, abdominal distension and pain. The common pathogenic bacteria of urinary tract infection are Staphylococcus aureus, and the drug resistance rate of Staphylococcus aureus is as high as 62%, which makes western antibiotics and some traditional Chinese medicine helpless to treat the infection caused by this bacteria. The main ingredients are ten precious herbs, which use the multi-targeting effects of honeysuckle, Semen, Bian Cao, Quai, Shi Wei, Chuan Mu Tong, Che Qian Zi, Temperance, Mulberry, and Lan Xian Cao. The synergistic effect of Yin Yin Hua, Hibiscus, Quercus, Chuan Mu Tong, Che Qian Zi, Tempranillo, Mulberry and Lan Xian Cao, the bactericidal activity against G. aureus is significantly increased, and the sensitivity and antibacterial effect against G. aureus is stronger. The clinical treatment of urinary tract infection caused by Staphylococcus aureus is more effective and more stable. Chinese medicine treatment has the characteristics of treating both the symptoms and the root cause, attacking and supplementing at the same time, fully reflecting the treatment characteristics of traditional Chinese medicine theory “seven parts treatment, three parts nourishment”, which can effectively consolidate the efficacy and reduce the recurrence of cystitis. The total effective rate of 93.6% has been clinically verified by many large institutions such as Jilin Provincial Hospital of Traditional Chinese Medicine and Jilin Provincial Hospital, which is the ideal Chinese medicine for treating urinary tract infection diseases. In addition, it has been clinically proven that Yinhua Urolithian Tablet is also effective in treating bacterial cystitis by applying the method of Bazhensan plus or minus.