Interstitial Cystitis - PPT.pptx AND ITS TREATMENT

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1. CBDC 2 ND BHMS COURSE DAY - FRIDAY DATE - 18/10/2024 TOPIC - Interstitial Cystitis PRESENTED BY - DR. MRS. M. A. NERLEKAR

2. Definition Interstitial cystitis (i.e., chronic pelvic pain syndrome) is a persistent, painful form of chronic cystitis occurring most frequently in women. It is characterized by intermittent, often severe suprapubic pain, urinary frequency, urgency, hematuria and dysuria without evidence of bacterial infection, The AUA guideline defines IC/BPS as "an unpleasant sensation (pain, pressure, discomfort) perceived to be associated with the urinary bladder, accompanied by lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes." IC has classically been used to describe the clinical syndrome of urgency/frequency and pain in the bladder and/or pelvic area.

3. Etiology Leaky epithelium, mast cell activation, and neurogenic inflammation, or some combination of these and other factors, contribute to a self-perpetuating process that results in chronic bladder pain and voiding dysfunction.

4. Etiology Urothelial dysfunction (GAG): Normal glycosaminoglycan layer (GAG) is affected by a defect/inhibition of urothelial proliferation (APF).

5. Clinical Presentation PAIN: Suprapubic or pelvic discomfort Bladder pain that intensifies with bladder filling and is relieved by voiding Dysuria Urinary frequency and urgency Nocturia: mild to severe (1 to more than 12 times per night) Spasms of the rectum and levator ani muscles Tenderness in the anterior vaginal wall, suprapubic area, and pelvic floor muscles during pelvic examination Women : - Dysfunction - Dyspareunia - Female sexual discomfort Men : - Pain at the tip of the penis, in the groin, or in the testes - Ejaculation frequently causes pain due to significant pelvic floor spasms - Tenderness in the prostate, bladder, testes, and epididymis

6. Diagnosis Inclusion Criteria Hunner’s ulcers Glomerulations on endoscopy Pain on bladder filling relieved by emptying Pain (suprapubic, perineal, pelvic, urethral) Decreased bladder compliance on cystometrogram Ex clusion Criteria < 18 years Bladder tumors TB cyst Bacterial cystitis Gyn carcinomas Active herpes Bladder calculi Frequency < 5 in 12 hours Nocturia < 2 Symptoms relieved by antibiotics or urine analgesics Bladder cap > 400 ML Duration < 12 months

7. Diagnosis Diagnostic Criteria for Interstitial Cystitis : Category A : At least one of the following cystoscopic findings: Diffuse glomerulations (≥ 20 per quadrant) in at least 3 quadrants of the bladder A classic Hunner’s ulcer Category B : At least one of the following symptoms: Pain associated with the bladder Urinary urgency

8. Investigation Cystoscopy The classic picture is elusive ulcers with apperance of patches of red mucosa first described by Hunner 1914 (Hunner’s ulcer) Hunner's ulcer Glomurulations (punctuate petechial hemmorage) Both can be found in patients without IC and not all patients with IC have them (not reliable criteria)

9. Investigation Potassium Test An intravesical potassium chloride challenge (KCI test) has been proposed for diagnosis using a 0.4M potassium chloride solution Pain and provocation of symptoms by potassium constitute a positive test.

10. Treatment Conservative treatments first Behavioral modification : control fluid intake , timed voiding , pelvic muscle training Avoid surgery if possible Exception is fulguration of Hunner’s lesions, must be done first Multiple simultaneous treatments often best Pain management should be priority

11. Treatment Dietary Manipulation avoid acidic foods, coffee, tea, soda, spicy foods, artificial sweetener, and alcohol Oral Therapy Sodium pentosan polysulfate (Elmiron) Amytriptiline Cemetidine L-Arginine

12. Surgery Neuromodulation Bowel Surgery Total cystectomy and urethrectomy

13. References Robbins Basic Pathology National Institute of Diabetes and Digestive and Kidney Diseases Hanno PM, Burks DA, Clemens JQ, Dmochowski RR, Erickson D, FitzGerald MP, et al. AUA Guideline for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. Journal of Urology [Internet]. 2011 Jun 1 [cited 2024 Oct 17];185(6):2162–70. Available from: https://doi.org/10.1016/j.juro.2011.03.064

14. Thank You!