The document discusses interstitial cystitis and cystitis glandularis. It defines interstitial cystitis as an unpleasant bladder sensation for over six weeks without infection. Key points include that it predominantly affects women, has a multifactorial etiology possibly involving mast cells and neurobiology, and is diagnosed through history, exams, tests ruling out other causes. Treatment progresses from stress management, oral medications to more invasive options like botulinum toxin if conservative measures fail. Cystitis glandularis is a benign bladder condition caused by chronic irritation. It involves gland-like changes to the bladder lining and commonly affects men. Diagnosis is through imaging, cystoscopy and biopsy, with treatment being surgical if needed.

1. INTERSTITIAL CYSTITIS
& CYSTITIS
GLADULARIS
By Yacob Sh.
Moderator – Dr. Samodi
(Consultant Urologis)
March 5, 2023G.C

2. Outline
• Definition
• Epidemiology
• Etiology
• Clinical presentation
• Diagnosis
• Management
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3. INTERSTITIAL CYSTITIS
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4. Definition
“An unpleasant sensation (pain, pressure, discomfort)
perceived to be related to the urinary bladder,
associated with lower urinary tract symptoms (LUTS)
of more than six weeks duration, in the absence of
infection or other identifiable causes”
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5. Symptoms
• Pain
• Urgency
• Frequency
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6. Epidemiology
• A significant increase in IC/BPS prevalence estimates
• A female-to-male ratio of 5 : 1
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7. Etiology
• Multifactorial
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8. Cont’d
• Infection
• Proposed as a cause since the dawn of the disease
• Negative studies far outnumber positive ones
• Autoimmune
• The exact role remains controversial
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9. Cont’d
• Mast cell involvement
• Final common pathway
• Epithelial permeability
• Lead to sensitization of sensory nerves by irritants
• Inhibition of uroepithelial cell proliferation
• APF, a sensitive and specific biomarker for IC/BPS patients who
met NIDDK criteria
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10. Cont’d
• Neurobiology
• Activation of sensory nerves, specifically pain fibers, is known to
trigger neurogenic inflammation through release of neuropeptides
• Cross-sensitization
• An overlap of neurohumoral mechanisms
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11. Cont’d
• Urine abnormalities
• Inflammatory response induced by toxic, allergic, or
immunologic means
• Genetics
• A genetic component adds to the susceptibility to IC/BPS
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13. Pathology
• There is no histology pathognomonic of IC/BPS
• Histologic features can be bland or show inflammatory features
• Histopathology can distinguish IC/BPS+HL and IC/BPS-HL
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14. Diagnosis
• The most challenging aspect to accurately diagnose
IC/BPS is excluding other identifiable causes of
symptoms
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15. Cont’d
• Hx & P/E
• Urine studies
• Voiding diary
• Symptom scale
• Urodynamic evaluation
• Cystoscopy
• KCl test
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16. Cont’d
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17. NIDDK Criteria
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18. Treatment
• Treatment strategies should proceed using more
conservative therapies first
• Ineffective treatments should be stopped once a clinically
meaningful interval has elapsed
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19. Cont’d
First line
• General relaxation/stress
management
• Patient education
• Self-care/behavior modification
Second line
• Specialized manual physical therapy
• Oral agents: amitriptyline, hydroxyzine,
cimetidine, PPS
• Intravesical therapy: DMSO, heparin,
lidocaine
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20. Cont’d
Third line
• Cystoscopy under anesthesia with
hydrodistention
• Treatment of Hunner lesions
Fourth line
• Intradetrusor botulinum A toxin
• Neuromodulation
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21. Cont’d
Fifth line
• Cyclosporine A
Sixth line
• Urinary diversion (with or without
cystectomy)
• Substitution cystoplasty
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23. CYSTITIS GLANDULARIS
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24. Introduction
• Is a benign reactional metaplasia of the urothelium
• Occurs in the context of chronic irritation
• Pelvic lipomatosis is associated with glandular cystitis in
75% of cases
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25. Epidemiology
• Occurs in < 2% of the general population
• Commonly affects men
• It can occur at any age with extremes of 3 to 82 years
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26. Clinical feature
• Non specific
• LUTS + hematuria
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27. Diagnosis
• Imaging
• Cystoscopy
• Histological analysis of TUBR
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28. Cystoscopic appearance

29. Pathology
• Two forms of glandular cystitis are recognized:
• Typical
• Intestinal
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30. Treatment
Endoscopic
• TUBR
Surgical
• Cystectomy
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