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:

Overactive bladder ^[52]
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.

Workup

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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: Alpha Omega Alpha, American Association of Clinical Urologists, American College of Surgeons, American Urological Association, International Continence Society, International Society of Urology, Society of Pelvic Reconstructive Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

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.

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.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department 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 Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo, Antares.

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.