Interstitial cystitis and the painful bladder: a brief history of nomenclature, definitions and criteria.

"Practically every author writing on this subject has suggested a new name which only adds to the confusion and multiplication" (Kretschmer H, 1922). Despite multiple names and many definitions and classifications over the past two centuries, the medical world is no closer to discovering the cause or causes of this enigmatic bladder disorder, currently known as interstitial cystitis, bladder pain syndrome or painful bladder syndrome and hypersensitive bladder. International consensus on nomenclature, definitions and diagnosis is now essential to ensure that studies are carried out on the same basis, thereby generating meaningful data that can be relied on for further use. In our electronic age, multiple names and definitions cause confusion for researchers, clinicians and patients, even leading to the patient's diagnosis being unrecognized by authorities, resulting in refusal to reimburse treatment or provide social benefits. As the key to the puzzle lies in the patients, with all their symptoms and comorbidities, and as patients are directly affected by changes in nomenclature and definitions, patient organization representatives should be given every opportunity to participate in discussions on guidelines, taxonomy, definitions and terminology.

Un nuevo modelo experimental de inducción de cistitis intersticial mediante estrés oxidativo empleando instilación vesical de un gel donante de óxido nítrico / A new experimental model for inducing interstitial cystitis by oxidative stress using bladder instillation of a nitric oxide donor gel

Objetivo: La principal finalidad de este estudio es el desarrollo de un nuevo modelo experimental para la inducción de cistitis intersticial (CI) mediante la instilación vesical de una solución polimérica que contiene el S-nitrosoglutatión donante de óxido nítrico (GSNO), y su comparación con la cistitis intersticial experimental inducida por instilación vesical de protamina y cloruro potásico. Material y métodos: Para la consecución de nuestro objetivo utilizamos 40 hembras de rata Wistar divididas en cuatro grupos: a) solución salina + GSNO; b) solución salina + solución polimérica (sin GNSO); c) sulfato de protamina + KCl; y d) sulfato de protamina + GSNO. Se realizó bien una aplicación a las ratas (5 animales), bien 3 aplicaciones (5 animales) de la sustancia correspondiente mediante instilación vesical, y al cabo de 6 días (5 animales) o 9 días (5 animales)se les practicó la eutanasia y se les extrajeron las vejigas para su evaluación macroscópica y estudio histológico. Resultados: En términos de evaluación macroscópica observamos edema e hiperemia de la mucosa en dos (22%) de los animales del grupo 1, en 0 (0%) de los del grupo 2, en 10 (100%) de los del 3 y en 5 (50%) de los animales del grupo 4. En el grupo de protamina + KCl y en solución salina + GSNO se observaron efectos similares en la pared vesical. Los animales del grupo 2 (solución salina + polimérica) mostraban congestión vascular, bastante menos significativa que en el resto después de 9 días de instilaciones (p = 0,0035). Se observó un aumento de la fibrosis tras las instilaciones en los grupos 3 y 4 a los 6 días (p = 0,3781) y a los 9 días (p = 0,0459) respectivamente, en comparación con los controles (grupo 2). En todos los grupos aparecía un infiltrado de neutrófilos con intensidad variable a los 6 días de las instilaciones (p = 0,7277). Al cabo de 9 días se producía una regresión del infiltrado, y sin evidencias de reacción neutrofílica marcada en todos los grupos (p = 0,2301). Conclusión: La respuesta inflamatoria a la instilación vesical de una solución acuosa de Snitrosoglutatión fue muy parecida a la inducida por la instilación vesical de protamina y KCl. La instilación de una solución acuosa de GSNO puede considerarse un nuevo modelo para la inducción experimental de cistitis intersticial (AU)

Purpose: The aim of this study is to develop a new experimental model of inducing interstitial cystitis (IC) through vesical instillation of a polymeric solution containing the NO donor S-nitrousglutathione (GSNO) and to compare it to the experimental interstitial cystitis inducedby vesical instillation of protamine and potassium chloride. Material and method: For that purpose 40 female Wistar rats were used, divided in four groups: 1. saline solution + GSNO; 2. saline solution + polymeric solution (without GNSO); 3. Protamine sulphate + KCl; 4. protamine sulphate + GSNO. The rats received one application (5 animals) or 3 applications (5 animals) of the corresponding substance through intravesical instillation, and after 6 days (5 animals) or 9 days (5 animals) they were euthanized and their bladders were removed for macroscopic evaluation and histological study. Results: In the macroscopic evaluation we observed edema and hyperemia of the mucosa in2 (22%) of the animals in group 1, in 0 (0%) of the animals in group 2, in 10 (100%) of the animals in group 3, and in 5 (50%) of the animals in group 4. In the protamine + KCl group and in saline + GSNO similar effects were observed on the bladder wall. The animals in group2 (saline + polymeric) showed vascular congestion, significantly smaller than the rest after9 days instillations (p = 0.0035). Significant increased fibrosis was observed after instillations in groups 3 and 4, after 6 days (p = 0.3781) and 9 days (p = 0.0459) respectively, when compared to control (group 2). All groups presented neutrophilic infiltrate of variable intensity 6 days after instillations (p = 0.7277). After 9 days, there was a regression of the infiltrate, with no evidence of accentuated neutrophilic reaction in all the groups (p = 0.2301). Conclusion: The inflammatory response to bladder instillation of an aqueous solution of Snitrousglutathione was very similar to that induced by bladder instillation of protamine and KCl. Instillation of an aqueous solution of GSNO can be considered a new model for experimental induction of interstitial cystitis (AU)

The historical origins of interstitial cystitis.

PURPOSE: We identify early descriptions of interstitial cystitis and trace its evolution as a clinical entity during the 19th century. MATERIALS AND METHODS: Primary and secondary source documents relating to interstitial cystitis, bladder inflammation and bladder stones were reviewed. RESULTS: What is believed to be the earliest published record of interstitial cystitis appeared in an 1836 textbook by the Philadelphia surgeon Joseph Parrish, who documented a syndrome of chronic frequency, urgency, dysuria and pelvic pain he called "tic doloureux of the bladder." Tic doloureux was a contemporaneous diagnosis used to describe painful, idiopathic disorders of nerves. Parrish attributed this term to his mentor, Dr. Phillip Syng Physick, who applied it to patients with severe lower urinary tract symptoms with no discernible etiology, with the most common etiology during the 19th century being bladder stones. A review of archival material from the Philadelphia College of Physicians indicates that by 1808 Physick had developed a concept of bladder inflammation, a "bladder ulcer," that produced lower urinary tract symptoms in the absence of bladder stone. CONCLUSIONS: By 1808 Philip Syng Physick had described an inflammatory condition of the bladder producing the same lower urinary tract symptoms as a bladder stone. By 1836 he had expanded this concept to include a chronic frequency, urgency and pain syndrome occurring in the absence of demonstrable etiology. We propose that these are the earliest known descriptions of bladder inflammation and interstitial cystitis.

Interstitial cystitis

This book attempts to summate the current state of knowledge regarding IC. Hopefully it will also act as a stimulus for clinicians and researchers to advance our understanding and treatment of this syndrome ..... I hope this book meets the need of its intended readership: urologists, gynecologists, basic researchers, pain clinic specialists, nurses and patients. The book outlines the current approach to diagnosis and treatment of IC and provides an up-to-date summation of current research into the etiology and pathogenesis of the disease. Researchers entering the field of IC research, and those contemplating same, should find this text a useful compendium (AU)