[Interstitial cystitis]

Interstitial cystitis, first described one hundred years ago, is difficult to classify in urological pathology. It essentially affects middle-aged women. Two main theories are currently proposed to explain its pathogenesis: the permeable epithelium theory and the mast cell theory. However, other factors are also involved: vascular, neurological, infectious and immune. This disease has a chronic course with no transformation of the nonulcerative form into the ulcerative form. There are no specific histological criteria, even the presence of mast cells in the bladder wall. However, histology is able to exclude other bladder disease, principally carcinoma in situ. The diagnosis is therefore based on clinical examination and endoscopy, after excluding other diseases. The essential complementary investigations are cystoscopy and cystomanometry which must be performed according to rigorous protocols. Conservative treatment is based on vesical hydrodistension, bladder retraining, bladder instillations (DMSO) and systemic treatments (sodium pentosanpolysulfate). Surgery is required in 1 to 5% of cases due to failure of medical treatment and the severity of the symptoms. Electrical or laser coagulation of the ulcers is effective. Partial cystectomy with cystoplasty is reserved for forms sparing the trigone, while cystourethrectomy and urinary diversion may be indicated in other more advanced and refractory cases.