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PRACTICE: Joseph L Onwude What is the most effective treatment of interstitial cystitis? BMJ 2008; 337: a2325 [Full text]

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Diagnosis of Interstitial Cystitis

Rosalind Maskell   (2 March 2009)

Diagnosis of Interstitial Cystitis 2 March 2009
Rosalind Maskell, Retired St Mary's Hospital, Portsmouth (formerly) Send response to journal: Re: Diagnosis of Interstitial Cystitis	In 1989 my colleagues and I reported on a search for infection in the urine and bladder tissue of 20 patients who fulfilled the current criteria for diagnosis of interstitial cystitis.All had the characteristic histological appearance of the bladder tissue and repeated apparently negative urine cultures. We sought a possible infective aetiology by culture of bladder tissue, catheter and midstream specimens of urine,and urethral swabs by methods capable of detecting organisms which are not detected by standard aerobic urine culture methods. Details of the culture methods are given in the paper. Bacteria were isolated from the catheter specimens and/or bladder biopsies of 12 patients. 8 of these organisms were of species that did not grow after overnight incubation on a standard urine culture medium: Gardnerella vaginalis (6), Lactobacillus sp (2).These species were also isolated from the midstream urine and/or urethral swab of 6 other patients. The correlation of the histological and bacteriological findings supports the hypothesis of an infective aetiology and suggests that the so-called urethral syndrome and interstitial cystitis may be the earlier and later stages of the same disease process. Early diagnosis might prevent progression to the stage at which a diagnosis of interstitial cystitis is made.This could be achieved by searching for bacteria other than the common aerobes in the urine of patients with apparently 'sterile' pyuria and in all catheter specimens collected at cystoscopy from patients suspected of having interstitial cystitis. The complexity and often unsatisfactory management regimes used to treat these patients are clearly set out in Onwude's paper. Detection and appropriate management at an early stage of the disease process probably offers the best hope for patients with this troublesome condition. 1. Wilkins EGL, Payne SR, Pead PJ, Moss ST, Maskell RM. Interstitial cystitis and the urethral syndrome: a possible answer. Br J Urol 1989;64:39-44. Competing interests: None declared