What is the value of cystoscopy with hydrodistension for interstitial cystitis?

• Drs. Fall and Peeker question the prudence of dispensing with traditional cystoscopy with hydrodistension and bladder biopsy findings as diagnostic criteria for IC. We note simply that the data do not support their use. Cystoscopic findings lack specificity and correlate poorly with symptoms.1 Our study was similar to others: patients who satisfied the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases (NIDDK) criteria were no different than those who did not satisfy the NIDDK criteria, other than more intense symptoms or smaller bladder capacities.1 and 2 In essence, patients with IC are diagnosed primarily by history, physical examination findings, and negative urinalysis and urine culture results, and the select use of other tests to exclude other conditions. We wish to be unambiguous: cystoscopy is indicated to exclude bladder cancer, and biopsy of any suspicious lesion is indicated. However, the message remains: cystoscopy with hydrodistension does a lousy job at ruling in or ruling out IC. Although Fall and Peeker have reported that mast cells are increased in IC and may be a potential diagnostic criterion, mast cells are more consistently increased in Hunner’s ulcers than elsewhere in IC bladders, and increased mast cell counts are not specific to IC. Mast cell counts or urine methylhistamine levels are similar between patients meeting and not meeting the NIDDK criteria.3 IC biopsy findings show significant changes, but, again, primarily from Hunner’s ulcers and not from nonulcerated areas of IC bladders.4 Patients with nonulcerative IC show mast cell counts no different than those of controls.5 Because Hunner’s ulcers are seen in less than 10% of cases, a criterion requiring elevated mast cell counts or biopsy changes to diagnose IC would falsely exclude more than 90% of patients from the diagnosis. The danger is not “that a variety of conditions are aggregated,” but rather, that by requiring patients to satisfy restrictive criteria (of questionable relevance), we simply fail to diagnose patients other than those with long-standing and severe manifestations of IC, the “quagmire” that exists currently.6 That trend has to change. Although the European working group in 2003 believed that cystoscopy with hydrodistension and bladder biopsy remain important, it is noteworthy that in the same year, separate international expert panels convened in Japan and Bethesda, Maryland could reach no consensus to support cystoscopic or biopsy criteria for diagnosis.7 IC generates controversy, and many urologists share the traditional views and continue to diagnose by cystoscopy, despite data that question cystoscopy as a diagnostic test for IC, and despite data that question subsetting patients with IC by the cystoscopic results.1, 2 and 8 In this respect, diagnostic cystoscopy with hydrodistension and bladder biopsy findings are outdated.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)

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