Main description:

Until recently interstitial cystitis was considered a urologic curiosity, a rare problem with relatively specific diagnostic criteria that many urologists would see only once or twice in a decade. This has changed drastically in the last ten years. Interstitial cystitis is now a very controversial subject that has ignited the interest of physicians in general, urologists in particular, basic scientists and even government agencies. It is a potentially much more common and more devastating disorder (or group of disorders) than had been believed. The exponential growth in clinical and basic research is largely due to the efforts of patient groups who demanded that more attention be paid to this problem. We owe them a debt of gratitude for putting interstitial cystitis in the spotlight and quite literally under the microscope. In this book we have attempted to put together the current views of experts from around the world regarding the many aspects of this disorder. It is hoped that we can provide an image of where we stand as we enter the 1990s. If the book can stimulate other physicians and basic scientists to enter this exciting field of research, and if it can provide hope to the many thousands of patients who suffer from this disease, we will consider it a success. Acknowledgement This book is dedicated to the Interstitial Cystitis Association and its hundreds of members who have contributed so much of their time and effort toward making this disease less of a mystery.

Contents:

Section 1 Introduction.- 1 Interstitial Cystitis: An Introduction to the Problem.- Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshops on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland 28–29 August, 1987 and 22 November, 1988.- 2 Historical Perspectives.- Section 2 Epidemiology and Etiology.- 3 Epidemiology of Interstitial Cystitis: 1.- Prevalence.- Incidence.- Sex.- Age.- Severity Grades.- Interstitial Cystitis in Urological Practice.- 4 Epidemiology of Interstitial Cystitis: 2.- Prevalence and Incidence of Interstitial Cystitis.- Diagnosis.- Patient Reports on Diagnosis of IC.- Patient Demographics.- Social and Economic Cost of IC.- Discussion.- Appendix: IC Screening Criteria.- 5 Interstitial Cystitis: Animal Models.- Current Research Strategies.- Experimental Models.- Mucin Extraction.- Studies.- Acute Administration of Nitrofurantoin.- Chronic Administration of Nitrofurantoin.- What Constitutes an Experimental Animal Model of Interstitial Cystitis?.- 6 Etiology: Etiologic and Pathogenic Theories in Interstitial Cystitis.- General Remarks on Etiology and Pathogenesis.- The Etiologic Agent.- The GAG Layer and Urothelium in the Pathogenetic Processes.- The Inflammatory Processes in the Bladder Wall.- Neurogenic and Psychiatric Aspects of Etiology and Pathogenesis.- Conclusions.- Editorial Comment Etiologic Theories: Deficiency of the Bladder Lining.- Section 3 Diagnosis.- 7 Light Microscopic Findings in Bladders of Patients with Interstitial Cystitis.- 8 Pathology of Interstitial Cystitis.- 9 Mast Cells and Interstitial Cystitis.- Mucosal Mast Cells in the Rat.- Mucosal Mast Cells in Man.- Proliferation and Intraepithelial Distribution of MMCs.- Mast Cells in Interstitial Cystitis.- Implications.- 10 Diagnosis of Interstitial Cystitis: A Clinical, Endoscopc and Pathologic Approach.- Symptomatology.- Diagnosis.- Pathologic Features.- Bladder “Mastocytosis”.- Summary.- 11 Neurourologic Evaluation in Interstitial Cystitis.- Urgency and Frequency.- Cystometrograms and Other Urodynamic Tests and Uncomfortable Bladder Symptoms.- Urethral Activity and Uncomfortable Bladder Symptoms.- Assessment of Bladder Compliance (Ability to Tolerate Volume Increments) and Interstitial Cystitis.- Urodynamic Testing and Physical Volume Restriction.- 12 Hydrodistension and Intraoperative Urodynamics.- History of Intravesical Hydrodistension.- Helmstein’s Techniques.- Diagnosis.- Complications.- Intraoperative Urodynamics During Hydrodistension.- Conclusion.- Editorial Comment The Clinical Evaluation of Patients with Painful Bladder Disease.- Interstitial Cystitis.- Section 4 Management.- 13 Pharmacotherapeutic Goals in Interstitial Cystitis.- Corticosteroids.- Immunosuppressive Drugs.- Anti-Inflammatory Drugs.- Antihistamines.- Sodium Pentosanpolysulfate.- Heparin.- Amitriptyline.- Dimethyl Sulfoxide (DMSO).- Oxychlorosene Sodium (Clorpactin WCS 90).- Silver Nitrate.- Disodium Cromoglycate.- 14 Intravesical Therapy of Interstitial Cystitis.- Silver Nitrate.- Clorpactin WCS 90.- Dimethyl Sulfoxide (DMSO).- 15 Subcutaneous Heparin in the Treatment of Interstitial Cystitis.- Administration and Dose.- Comments.- 16 Urine Eosinophil Cationic Protein in Painful Bladder Disease.- Eosinophil Cationic Protein (ECP).- ECP and IC.- Comments.- 17 Use of Pentosanpolysulfate in the Management of Interstitial Cystitis.- Materials and Methods.- Patients.- Oral Study.- Subcutaneous Therapy.- Results.- Comments.- 18 Use of Transcutaneous Electrical Nerve Stimulation in the Management of Chronic Interstitial Cystitis.- Clinical Trials.- Intravaginal Versus Suprapubic Stimulation.- Long-Term Follow-Up of Suprapubic Stimulation.- Suprapubic Stimulation in Classic and Non-Ulcer IC.- Common Peroneal or Posterior Tibial Nerve Stimulation.- Comment.- 19 Reappraisal of Transurethral Resection in Classic Interstitial Cystitis.- Update on the Author’s Own Experience.- Comments.- 20 Treatment of Interstitial Cystitis with the Neodymium:YAG Laser.- Materials and Methods.- Results and Conclusions.- 21 Partial Bladder Denervation in the Treatment of Interstitial Cystitis in Women.- Indications.- Selection of Patients.- Operative Techniques.- Post-Operative Management.- Results.- 22 Surgical Therapy of Interstitial Cystitis.- Surgical Treatment.- Augmentation Cystoplasty.- Objectives and Goals.- Indications and Patient Selection.- Historical Perspective.- Principles and Caveats.- Choice of Bowel Segment.- Our Technique.- Series Review.- Risks and Complications.- Cystectomy and Total Bladder Substitution.- Surgical Technique.- Results and Complications.- Editorial Comment Substitution Cystoplasty in the Management of Interstitial Cystitis.- Addendum. Summary of the 1989 AUA Podium Section on Genitourinary Infection: Interstitial Cystitis.