Associates In Urology: IC Diagnosis

Interstitial Cystitis (IC)

DIAGNOSIS

The diagnostic process in IC is exclusionary and other conditions that lead to similar bladder symptoms need to be ruled out first. These conditions are bacterial infections (UTI’s), non-infectious or tuberculosis related cystitis (bladder inflammation), bladder cancer or carcinoma in situ (CIS), overactive bladder (OAB) or other bladder dysfunction, vaginitis or urethral diverticulum. So far, there is no specific and/or unequivocal laboratory test to confirm the diagnosis of IC. Therefore the diagnostic process of IC includes a routine history, meticulous physical examination and preliminary laboratory tests such as urine for cultures (UTI), for TB and cytology (abnormal and malignant cells in the urine), cystoscopy and urodynamic studies.

For decades cystoscopy under general anesthesia with hydrodistention of the bladder has been the preferred diagnostic modality where the findings of hyperemic (increased vascularity) bladder changes, glomerulations (pinpoint submucosal hemorrhages) and bladder ulcerations (Hunner’s ulcers) were considered diagnostic for IC.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institute of Health (NIH) established in 1987 the clinical criteria for the diagnosis of IC. These criteria are mostly utilized in research projects and almost never been applied to the clinical decisions among treating physicians.

Urodynamics (an office based bladder function test) is advisable when bladder dysfunction is considered to be a cause the symptoms and it is indicated especially when high post void residuals are found, in questionable overactive bladder (OAB) condition or when the patient has some neurological history. The Urodynamic findings of sensory urge (early onset of a strong urge to urinate with or without pain but without documentation of involuntary bladder contractions) are highly suspicious for IC.

by Yitzhak Berger, M.D.

Updated June 23rd, 2007