Light Microscopic Findings in Bladders of Patients with Interstitial Cystitis

Abstract

In recent years it has been demonstrated that interstitial cystitis (IC) is more of a syndrome than a specific disease entity (Fall et al. 1987). Most urologists establish the diagnosis by a triad of clinical findings which include:

• 1 Characteristic irritative voiding symptoms including urgency and pain

• 2 The absence of objective evidence of other diseases that could cause these symptoms (including sterile urine)

• 3 Atypical cystoscopic appearance which generally is demonstrated with the patient under anesthesia (Messing 1987) In patients with these symptoms two different cystoscopic appearances have been identified. The first patient category includes patients with an ulcer disease, as initially described by Hunner (1918). The second patient category does not display any ulcerations of the bladder mucosa, only strawberry-like hemorrhages, referred to as glomerulations. Patients with these features, which were initially described by Messing and Stamey in 1978, were said to suffer from “early interstitial cystitis.” Practically all subsequent studies of interstitial cystitis have failed to subclassify the patients according to the two different cystoscopic patterns. The histopathologic findings in patients with IC generally have been described as nonspecific (Smith and Dehner 1972: Messing and Stamey 1978). Furthermore, many urologists, especially in the USA, do not obtain transurethral resection biopsies but only forcep or cold cut biopsies, which markedly limit the material available for histopathological evaluation.