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Purpose: We examined the complications in the diagnosis and treatment of interstitial cystitis in daily clinical practice., Materials and Methods: The study included 82 patients who were suspected of having interstitial cystitis at our hospital from March 2002 to April 2013. All hydrodistention procedures were performed with the aid of an anesthesiologist, as recommended by the Ministry of Health, Labour, and Welfare since April 2010., Results: Of the 82, 20 patients were male and 62 were female, (mean age at diagnosis 53 years.) Six of the suspected cases did not have interstitial cystitis. Of the 67 patients diagnosed with interstitial cystitis during hydrodistention, 29 (43%) did not experience pain. The time taken to diagnose these asymptomatic patients was longer than that taken for those who experienced pain. Twenty-eight patients (42%) discontinued treatment because it was ineffective., Conclusion: Interstitial cystitis has been widely recognized, but general physicians are unable to provide a diagnosis and suggest aggressive treatment because of difficulty associated in the treatment and diagnosis. To resolve these issues, physicians should be keep in mind that interstitial cystitis involves a hypersensitive bladder, and that some patients may not experience pain. Further, knowledge about Hunner's ulcer is essential. We believe that the most important points are improving health insurance about facility criteria of hydrodistention, and evaluating behavioral modification and dietary manipulation.

The efficacy of acupuncture and moxibustion treatment was examined on eight female patients with refractory interstitial cystitis (IC) who had been treated conservatively with hydrodistension, intravesical instillation of dimethyl sulfoxide, or oral medication. These patients had received hydrodistension on an average of 2.3±1.8 times. Moxa needles were applied to Ciliao in bladder meridian 32 and Xialiao in bladder meridian 34, and electroacupuncture was performed on Zhongliao in bladder meridian 33 at 3 Hz for 20 min once a week. The bladder condition was assessed by the visual analogue scale (VAS) score, the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), the Interstitial Cystitis Problem Index (ICPI), and the maximum voided volume (MVV). After 3 months, patients who showed a reduction of >2 in their VAS score, reduction of <30% of ICSI and ICPI, and increase of >100 ml MVV were considered responders. There were three responders, and after repeated therapy to maintain these effects, they no longer required hydrodistension. Two responders had no recurrence for 48 months or more. Acupuncture and moxibustion resulted in improvement in 38% of the patients (3/8) with refractory IC, and repeated therapy maintained the therapeutic effects. This therapy is traditional and relatively noninvasive. Although its precise mechanism of action is unclear, this study suggests that acupuncture and moxibustion treatment may be a complementary and alternative therapeutic option for refractory IC.

We retrospectively analyzed the clinical relevance of hydrodistention under anesthesia for patients having urgency and/or lower abdominal pain who were clinically diagnosed as having interstitial cystitis (IC) from May 1996 to May 2005. Their symptoms were refractory to anticholinergic or antiinflammatory agents. Hydrodistention was performed under general or spinal anesthesia with direct vision by cystoscopy and irrigation fluid was instilled into the bladder at a pressure of 80 cmH2O. Cystoscopic findings revealed glomerulation in 26 patients (96%), cracking in 10 (37%) and Hunner's ulcer in 3. Twenty-four patients (89%) obtained improvement of the objective symptoms after treatment. However, symptoms soon deteriorated in 16 patients, and the average duration of efficacy was only 4.7 months (SD; +/-3.7). There were two episodes of complication in this treatment. Bladder rupture occurred during hydrodistention, but was successfully managed with simple percutaneous perivesical drainage. One patient with acute pyelonephritis was treated with an antimicrobial agent without any additional treatment. Although bladder specimens were examined by immunohistochemistry, tryptase and c-kit were not linked with the mast cell count, severity of symptoms or treatment efficacy. Hydrodistention of the bladder may be recommended as the first treatment choice for patients with IC because it provides relatively high efficacy. However, the short duration of the efficacy requires a second-line treatment option for better management of patients with IC.

Purpose: To examine clinical features of the patients of interstitial cystitis (IC) undergoing hydrodistension at our institution., Materials and Methods: We retrospectively evaluated 52 IC patients who underwent hydrodistension between July 2002 and December 2004. Transurethral coagulation (TUC) of Hunner's ulcer (HU) was subsequently performed for patients with HU (ulcer type). Descriptive statistics of the patients' characteristics and outcomes were provided and compared between ulcer type and nonulcer type IC patients., Results: Of the 52 patients, 44 (85%) were female and 8 were male. Mean symptom duration at diagnosis was 59 months (range 2 to 388). Mean patient age was 55 years (range 24 to 78). Of them, 92% reported urinary frequency, 54% bladder or lower abdominal pain and 40% voiding difficulty. The daily voiding frequency was 19 times (range 8 to 52) and mean bladder capacity by voiding log was 100 ml (range 33 to 260). The mean of bladder capacity at hydrodistension was 580 ml (range 220 to 880). All the patients showed glomerulations during hydrodistension and 75% of them experienced amelioration of their symptoms after hydrodistension. Symptom relief lasted for 1 year for two thirds of the patients. Mean observation period was 15 months (range 2 to 30 months). Of 52 patients, 19 (37%) were ulcer type, who were significantly older at diagnosis (60 yrs vs. 52 yrs), had smaller maximum bladder capacity of voiding log (140 ml vs. 230 ml) and bladder capacity at hydrodistension (500 ml vs. 620 ml). However, ulcer type IC patients responded significantly better to hydrodistension (95%vs. 64%)., Conclusions: IC patients suffered from severe symptoms for a long time without correct diagnosis or proper treatments. Hydrodistension was effective for IC patients, especially for ulcer type, combined with TUC.

A case is a 62 years old woman who consulted her family physicion with pollakiuria and sharp pain at the time of urinary bladder distention. Since anti-H1-antagonist but not antibiotics was partially effective against the symptoms and some specific food ingestion appeared to increase the bladder pain, she was referred to our hospital. Treatment with spulatast tosilate and elimination of food products that revealed the presence of specific IgE antibodies and positive skin reactiont resulted favorable clinical response. Cystoscopic examination showed reduction in bladder capacity, mucosal injection and vascularization, besides pinpoint submucosal hemorrage and linear ulcer by hydrodistension. The diagnosis of interstitial cystitis was established by those evidences and histological findings. The patient got apparent remission after the bladder hydrodistension and is now in steady state with an addition of suplatast tosilate, a Th2 cytokine inhibitor, on the treatment mentioned above. Interstitial cystitis is a very rare disease which is characterized by cystitis-symptoms with normal urinary finding and non-effectiveness of antibiotics. The pathogenesis of the disease is unclear but considered as allergic inflammation. We report a case of interstitial cystitis accompanied by food allergy.