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Interstitial cystitis in children
C E Close1, M C Carr, M W Burns
1Division of Pediatric Urology, Children's Hospital and Medical Center, Seattle, Washington, USA.
Insights
Interstitial cystitis (IC), a rare condition in children, presents with bladder pain, urgency, and frequency. Diagnosis is confirmed by cystoscopy, and hydrodistension offers symptom relief, though repeat treatments may be needed.
Area of Science:
- Pediatric Urology
- Urology
- Pediatric Nephrology
Background:
- Interstitial cystitis (IC) is infrequently documented in pediatric populations.
- Chronic bladder pain, sensory urgency, and frequency are key symptoms.
Purpose of the Study:
- To report on the clinical experience with 16 children diagnosed with interstitial cystitis.
- To highlight the diagnostic criteria and treatment outcomes for pediatric IC.
Main Methods:
- Retrospective chart review of 20 children with chronic sensory urgency, frequency, and bladder pain.
- Exclusion of 4 patients due to infection or lack of cystoscopic changes post-hydrodistension.
- Analysis of clinical presentation, cystoscopic findings, urodynamics, and treatment response.
Main Results:
- 16 children diagnosed with IC, with symptom onset between 2-11 years.
- 88% presented with urinary frequency and sensory urgency; 81% reported pain relieved by voiding.
- All patients showed glomerulations and terminal hematuria post-hydrodistension; 93% experienced symptom relief, 50% requiring repeat hydrodistension.
Conclusions:
- Pediatric IC is characterized by bladder pain, frequency, and urgency with specific cystoscopic findings.
- Hydrodistension is an effective treatment, though recurrence may necessitate repeat procedures.
- Distinguishing IC from dysfunctional voiding is crucial, as the latter involves involuntary bladder contractions.
Purpose:
Interstitial cystitis has been rarely reported in children. We present our experience with 16 children in whom clinical symptomatology and cystoscopic findings were consistent with the diagnosis of interstitial cystitis.
Materials And Methods:
We retrospectively reviewed the charts of 20 children referred for chronic sensory urgency, frequency and bladder pain who underwent cystoscopy and hydrodistension. Four patients were excluded from study because of infection identified at cystoscopy or lack of cystoscopic changes with hydro-distension.
Results:
Patient age at onset of first symptoms ranged from 2 to 11 years (median 4.5) and age at diagnosis ranged from 3 to 16 years (mean 8.2). Of the 16 children 14 (88%) presented with symptoms of urinary frequency and sensory urgency, and in 13 (81%) lower abdominal pain was relieved by voiding. None of the children had motor urgency. Urodynamic evaluation in 8 cases revealed early bladder sensation with no evidence of involuntary bladder contractions. Diffuse glomerulations and terminal hematuria were demonstrated in all patients after hydro-distension. Followup was available for 14 patients. Relief of symptoms occurred after hydro-distension in all children except 1. Seven children (50%) required repeat hydro-distension.
Conclusions:
Children with symptoms of bladder pain, urinary frequency and sensory urgency have bladder changes on cystoscopy consistent with interstitial cystitis. Although rare, this condition is recognizable and it should not be confused with dysfunctional voiding in which complaints are secondary to involuntary bladder contractions.