Urology - interstitial cystitis

Question 1

What is interstitial cystitis?

Answer 1

Interstitial cystitis is a chronic condition causing inflammation in the bladder, resulting in lower urinary tract symptoms and suprapubic pain.

Don’t need to remember lots of detail - just keep this in mind as a differential to be aware of of a UTI

Question 2

Presentation of interstitial cystitis

Answer 2

The symptoms are similar to a lower urinary tract infection, but are more persistent.

The typical presentation is more than 6 weeks of:

• Suprapubic pain, worse with a full bladder and often relieved by emptying the bladder
• Frequency of urination
• Urgency of urination
• Symptoms may be worse during menstruation

Much more common in women

Question 3

Investigations

Answer 3

To rule out other causes of these symptoms:

• Urinalysis for UTIs
• Swabs for STIs
• Cystoscopy - for bladder cancer
• Prostate examination for prostatitis, hypertrophy or cancer

Question 4

What may be seen on cystoscopy in interstitial cystitis?

Answer 4

Hunner lesions - seen in 5-20% patients - red, inflamed patches of the bladder mucosa associated with small blood vessels.

Granulations - tiny haemorrhages on bladder wall

Question 5

Management options broadly

Answer 5

Don’t really need to know this in depth

Supportive management - used initially e.g. bladder retraining and pelvic floor exercises, smoking cessation

Medications e.g. analgesia, anticholinergics e.g. Oxybutynin

Surgical procedures e.g. Botox injections to bladder, cauterisation of Hunner lesions during cystoscopy