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Interstitial Cystitis Differential Diagnoses

  • Author: Eric S Rovner, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Dec 09, 2015
 
 

Diagnostic Considerations

Diagnosing interstitial cystitis remains difficult even more than a century after it was described by Skene, in 1887. No pathognomonic findings exist with regard to patient history, physical examination findings, laboratory findings, or cystoscopy findings. The exclusion of other clinical entities remains the foremost goal of the workup and evaluation of patients thought to have this condition.

A careful, complete, and empathetic history and physical examination are critical. Cystoscopy is an adjunctive, although important, study. The classic Hunner ulcer in the setting of a small-capacity bladder (ie, assessed under anesthesia) is rarely seen to confirm the diagnosis with certainty. Until interstitial cystitis is defined completely or a definitive marker becomes universally available, the diagnosis remains one of exclusion.

The differential diagnosis of urinary frequency, urgency, and/or pain includes the following types of conditions:

  • Infectious or inflammatory
  • Gynecologic
  • Urologic
  • Neurologic

Infectious or inflammatory conditions to consider include the following:

  • Recurrent urinary tract infection (UTI)
  • Urethral diverticulum
  • Infected Bartholin gland or Skene gland
  • Vulvovestibulitis
  • Tuberculous/eosinophilic cystitis
  • Vaginitis (eg, bacterial, viral [eg, herpes])
  • Schistosomiasis

Gynecologic causes to consider include the following:

  • Pelvic malignancy or mass (eg, fibroid, endometrioma)
  • Endometriosis
  • Mittelschmerz
  • Pelvic inflammatory disease
  • Genital atrophy

Urologic causes to consider include the following:

  • Bladder cancer or carcinoma in situ (CIS)
  • Radiation cystitis
  • Overflow incontinence
  • Acontractile detrusor
  • Prostatodynia
  • Chronic pelvic pain syndrome
  • Bladder outlet obstruction (eg, urinary retention with overflow incontinence)
  • Large postvoid residual volume
  • Open bladder neck (eg, intrinsic sphincteric deficiency, urolithiasis, urethritis)

Neurologic causes to consider include the following:

  • Neurogenic detrusor overactivity
  • Parkinson disease
  • Lumbosacral disk disease
  • Spinal stenosis
  • Spinal tumor
  • Multiple sclerosis
  • Cerebrovascular accident

Other possible diagnoses to consider include the following:

  • Dysfunctional voiding
  • Vulvodynia
  • Pelvic floor myalgia
  • Degenerative joint disease
  • Hernia
  • Inflammatory bowel disease
  • Gastrointestinal neoplasm
  • Diverticulitis
  • Adhesions from prior surgery

Clinically, the practitioner is somewhat obligated to consider these potential alternative diagnoses prior to diagnosing interstitial cystitis. The implications of a diagnosis of interstitial cystitis are profound in that it is a chronic condition without universally effective therapy.

 
 
Contributor Information and Disclosures
Author

Eric S Rovner, MD Professor, Department of Urology, Medical University of South Carolina College of Medicine

Eric S Rovner, MD is a member of the following medical societies: International Continence Society, Societe Internationale d'Urologie (International Society of Urology), American Association of Clinical Urologists, Society of Pelvic Reconstructive Surgeons, Alpha Omega Alpha, American College of Surgeons, American Urological Association

Disclosure: Received honoraria from Astellas for speaking and teaching; Received honoraria from Allergan for consulting; Received consulting fee from Pfizer for consulting; Received consulting fee from AMS for consulting; Received consulting fee from Medtronics for consulting; Received grant/research funds from NIH/NIDDK for investigator; Received grant/research funds from Ion Innovations .

Coauthor(s)

Colin Murrah Goudelocke, MD Assistant Professor, Department of Urology, Medical University of South Carolina College of Medicine

Colin Murrah Goudelocke, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Justin D Ellett, MD, PhD Resident Physician, Department of Urology, Medical University of South Carolina College of Medicine

Justin D Ellett, MD, PhD is a member of the following medical societies: American Federation for Medical Research, American Medical Association, American Society for Microbiology, Association for Academic Surgery

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Matthew Eskridge, MD Physician, Alliance Urology Specialists, Greensboro, NC

Matthew Eskridge, MD is a member of the following medical societies: American Urological Association and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Colin Goudelocke, MD, Physician, Academic Urology, Chattanooga, TN

Disclosure: Nothing to disclose.

Ricardo Sanchez-Ortiz, MD Assistant Professor of Urologic Oncology, University of Puerto Rico School of Medicine; Adjunct Assistant Professor, Department of Urology, The University of Texas MD Anderson Cancer Center

Ricarco Sanchez-Ortiz, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

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