Atlas of Hunner's lesions and glomerulations and their correlations with bladder computed tomography findings in...

This study presents characteristic cystoscopic findings for Hunner's and non-Hunner's interstitial cystitis/bladder pain syndrome (HIC and NHIC) and their association with bladder wall morphology assessed by computed tomography (CT) and urodynamic parameters.

Cystoscopic images and bladder CT from 212 patients diagnosed with HIC (n = 52) and NHIC (n = 160) were retrospectively reviewed. The correlations between cystoscopic findings and abdominal CT findings, urodynamic parameters and urinary biomarkers at baseline were examined.

Significantly lower bladder capacity was noted in patients with HIC than NHIC. Hunner's lesions could usually be identified through office-based cystoscopy without anesthesia. Different grades of glomerulation developed after cystoscopic hydrodistention in NHIC. Grade 0 or 1 glomerulation was observed in 77 (48.1%) NHIC patients, and grade 2 or 3 glomerulation in 83 (51.9%). The bladder wall thickness (BWT) in all patients with HIC showed focal or diffuse thickening on bladder CT. The rate of focal or diffuse bladder wall thickness was higher in NHIC patients with maximal bladder capacity (MBC) < 760 ml (54.5%) than ≥ 760 ml (28.7%) (p = 0.001). However, bladder wall thickness was not associated with glomerulation grade. The sites of focal BWT for Hunner's lesions were strongly correlated with the cystoscopic findings. Urinary inflammatory and oxidative stress biomarker levels were significantly higher in patients with HIC than NHIC, and inflammatory biomarkers were significantly higher in patients with diffuse BWT than those with focal BWT and smooth BWT. This study also showed characteristic cystoscopic findings of HIC and NHIC.

Hunner's lesions have distinct cystoscopic features and focal or diffuse BWT in bladder CT. Careful examine cystoscopic findings and bladder CT can accurately diagnose HIC and NHIC and facilitate earlier, more effective treatment.