Nomenclature

Unit One: Nomenclature and Definitions

In the early art of nineteenth century, Philip Syng Philip from Philadelphia described the painful inflammatory condition of urinary bladder as ‘tic douloureux’ or bladder neuralgia

The term Interstitial cystitis was first used in 1876, by Sameul D Gross, who described a painful condition of bladder in which all the layers, ie. Serosa, muscularis and the mucosa of bladder were thought to be affected by an inflammatory process.

Guy Hunner described the small capacity fibrotic bladder with an ulcer at the dome, which would bleed to touch. This was described as Hunner’s ulcer and the painful condition of urinary bladder was attributed to the presence of this ulcer. For next 60 years, this Hunner’s ulcer was thought to be the diagnostic criteria of this disease. This disease has been observed to affect mainly women, in the ratio of 9: 1.

Over the last two decades, interstitial cystitis has been understood as a heterogenous group of clinical conditions, which result in a painful condition of bladder. This has been initially termed as Painful bladder syndrome as the pain was perceived to be originating from the bladder. However soon it was realized that the pain was not necessarily generated from bladder, hence this term was fallacious and did not convey the true meaning of the disease. There fore, it was agreed upon by the global experts to call it Bladder pain syndrome.

Bladder Pain Syndrome (BPS) would be diagnosed on the basis of chronic pelvic pain, pressure or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom like persistent urge to void or urinary frequency. Confusable diseases as the cause of the symptoms must be excluded.

Magnus Fall has given the currently accepted description of a lesion upon cystoscopy, which technically need not be an ulcer. This is a pale stellate shaped area surrounded by hyperemic capillaries. This may have  fibrinous material at the center and cracks on distension of bladder to its capacity. It readily bleeds on touch and manipulation. The term Hunner’s lesion has therefore been  accepted as the scientific way of describing the lesion which is specific to Bladder pain syndrome.  However, its presence is not must for making a diagnosis of Bladder pain syndrome.

Glomerulations are small pinpoint hemorrhagic spots in mucosa of bladder in a patient with Bladder pain syndrome. They appear upon distension of bladder under anesthesia during cystoscopy. However they are not specific for Bladder Pain syndrome and can be seen in radiation cystitis, drug induced cystitis and in hemorrhagic cystitis.

Cystoscopy may be absolutely normal in a patient with bladder pain syndrome

ESSIC  Classification based on Cystoscopy with hydrodistension

Cystoscopy

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Biopsy

 not done normal glomerulation Hunner’s lession
not done XX 1X 2X 3X
normal XA 1A 2A 3A
Inconclusive XB 1B 2B 3B
Positive* XC 1C 2C 3C

 

  • Histology showing inflammatory infilirates and/or detrusor mastocytosis and /or granulation tissue and/or intrafascicular fibrosis.

Confusable diseases:

  1. Carcinoma
  2. Carcinoma in-situ
  3. Infection with intestinal bacteria infection
  4. Mycobacterium tuberculosis, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalis, Corynebacterium urealyticum, Candida species
  5. Herpes simplex
  6. Human Papilloma Virus
  7. Radiation cystitis chemotherapy-induced cystitis cyclophosphamide-induced cystitis ketamine induced cystitis
  8. Tiaprophenic acid induced cystitis bladder neck obstruction neurogenic outlet obstruction bladder stone
  9. Lower ureteric stone
  10. Urethral diverticulum
  11. Urogenital prolapse
  12. Endometriosis
  13. Vaginal candidiasis
  14. Cervical, uterine and ovarian cancer incomplete bladder emptying (retention)
  15. Prostate cancer
  16. Benign prostatic obstruction
  17. Chronic bacterial prostatitis
  18. Chronic non-bacterial prostatitis
  19. Pudendal nerve entrapment

GIBS Definition

The faculty at Global Interstitial cystitis Bladder Pain society (GIBS) has decided to use the term Interstitial cystitis/ Bladder pain syndrome (IC/BPS) to denote the most logical way of defining this clinical entity.

IC/BPS has been defined by the faculty of GIBS (01 May 2016 , Mumbai, India)

  • Pain or discomfort in lower abdomen and / or urogenital area
  • of more than 3 months duration
  • which is usually worst on full bladder
  • along with one or more lower urinary tract irritative symptoms like frequency, urgency, nocturia
  • with or without standard stigmata on cystoscopy
  • Provided another discernible pathology likely to cause these symptoms has been excluded

Now let’s move on to Etiopathogenesis