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Pathology of interstitial cystitis
Anna Rosamilia1, Yasuhiko Igawa, Shin Higashi
1annarosamilia@bigpond.com
Insights
Pathology plays a limited role in diagnosing interstitial cystitis (IC), a condition defined by clinical criteria. While some findings suggest a link to disease severity, bladder biopsies are not mandatory for IC diagnosis.
Area of Science:
- Urology
- Pathology
- Medical Diagnostics
Background:
- Interstitial cystitis (IC) is currently diagnosed using clinical criteria established by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
- Bladder biopsy and histological examination are not required for the routine clinical diagnosis of IC.
- Existing literature indicates common, yet non-specific and non-universal, pathological findings in IC, including epithelial changes and inflammation.
Purpose of the Study:
- To evaluate the role of pathology in the diagnosis and management of interstitial cystitis (IC).
- To review common pathological findings in IC and their association with disease severity.
- To reach a consensus on the utility of bladder biopsy in the clinical work-up of IC patients.
Main Methods:
- Workshop discussion involving participants considering the role of pathology in IC.
- Literature review of pathological findings in interstitial cystitis.
- Presentations on the association between pathology and disease severity.
Main Results:
- Pathological changes in IC are not universally present or specific; some studies show normal histology in up to 55% of IC patients.
- Abnormal pathology appears to correlate with more severe IC symptoms, lower cystoscopic capacity, and poorer prognosis.
- The decision to perform bladder biopsy varies based on geographical factors, research interests, and the need to rule out malignancy.
Conclusions:
- Bladder biopsy is considered a non-mandatory, optional test for interstitial cystitis (IC) diagnosis.
- Urine cytology is recommended for all IC patients.
- Bladder biopsy may be valuable for research and when other conditions are suspected, potentially aiding in understanding pathogenic processes and future etiology determination.
Abstract:
In this workshop the participants were asked to consider the role of pathology in the diagnosis and management of interstitial cystitis (IC). Currently, the NIDDK definition of IC is made on clinical criteria; bladder biopsy is not required for the clinical work-up and histology is not used as a diagnostic criterion. The literature review described the most common pathological findings to be epithelial denudation or ulceration, mononuclear inflammation, edema, congestion, hemorrhage, and mast cell activation. These pathological changes were not universal or specific with 55% of IC subjects in one study having histology that was normal and indistinguishable from control subjects. Presentations were made which generally confirmed an association between abnormal pathology and more severe disease as determined by symptoms, cystoscopic capacity, and prognosis. During the workshop it was clear that whether or not a biopsy was performed depended on a number of factors, for example, country of origin, the research interest of the unit, and the desire to exclude malignancy on histological grounds. The consensus, which was not unanimous, was that bladder biopsy was a-non-mandatory test in the clinical work-up of the patient with IC but that urine cytology should be performed. It was discussed that bladder biopsy be an optional test and particularly relevant when one was suspicious of other conditions and in IC research. It was hoped that bladder biopsy pathology will give clues to contributory pathogenic processes such as epithelial dysfunction and inflammation; and in the future, with the help of molecular biology, may help determine etiology.
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