[Interstitial cystitis. Current aspects]

Fifty-five cases of interstitial cystitis are reported, symptomatology in these 43 women and 12 men being of a severe nature: diurnal and nocturnal pollakiuria, supra-pubic pain. Disorders were always permanent and had been present for at least 6 months, diagnosis being confirmed by endoscopy. Initial bladder filling demonstrated the most important lesions (Hunner's ulcer) and allowed determination of bladder capacity. Decompression and a repeat vesical repletion showed mucosal hemorrhagic spots, establishing the diagnosis of interstitial cystitis. Biopsy forceps were used to obtain fragments of bladder wall for optical microscopy in all cases and electron microscopy in several patients. Histologic findings were compared with two control groups: a group of 30 patients with pollakiuria and dysuria but absence of hemorrhage during bladder distention; a group of 9 patients operated upon for other lesions and with normal bladders. Extracellular deposits were searched for in freshly frozen fragments (liquid nitrogen) in 10 patients, while 24 patients underwent immunologic tests. Finally electron microscopy was used to study vesical epithelium to detect epithelial cell junction. In contrary, optical microscopy by immuno-histochemistry was used to study cytoskeletal keratin filaments. Two groups in this series were distinguished: one with major forms (18 cases) and one with minor forms (37 cases) of the affection. In major forms, affecting elderly patients with reduced bladder capacity, lesions on endoscopy and first distention were apparent as Hunner's ulcer and hemorrhage covering the non-ulcerated mucosa with petechiae. Initial distention in minor forms showed normal mucosa with, on decompression and repeat distention, the appearance of hemorrhagic sub-mucosal spots in the mobile bladder structures.