interstitial cystitis
Introduction
Introduction to interstitial cystitis Interstitial cystitis (IC), also known as Hunner's ulcer, is a rare type of autoimmune type of chronic cystitis, a painful inflammation of the bladder. The cause of this inflammation is not known because no infectious microorganisms are found in the urine. Typical patients are middle-aged women with frequent symptoms of urination and dysuria. Puriria and hematuria are often seen under the microscope, and gross hematuria is occasionally seen and may require blood transfusion. The end result is often a shrinking bladder. According to cystoscopy, a small superficial hemorrhage and ulcer area was found to confirm the diagnosis. Many treatments have been tried, but there are no special effects. When the patient has intolerable symptoms and does not respond to any treatment, the bladder can be surgically removed. basic knowledge The proportion of illness: 0.005% Susceptible people: good for middle-aged women Mode of infection: non-infectious Complications: hydronephrosis, pyelonephritis, renal failure
Cause
Cause of interstitial cystitis
Blood vessels, lymphatic obstruction and infection (25%):
Vascular and lymphatic obstruction. Bladder fibrosis was thought to be caused by pelvic surgery or infection causing obstruction of the lymphatic vessels in the bladder wall and causing embolic vasculitis or persistent small arteriospasm caused by vasculitis, but lacking sufficient evidence. . It has been suggested that bacterial, viral or fungal infections may be the cause of IC, but no reports of the above three pathogens have been detected in IC patients.
Neurohumoral factors (20%):
Mast cells are increased in the bladder membrane and detrusor of IC patients. Cold, neuropeptides, drugs, wounds, toxins, etc. can activate mast cells, releasing vasoactive substances to sensitize sensory neurons, and the latter further release neurotransmitters. Or neuropeptides activate mast cells; mast cells can also directly cause vasodilation or inflammation of the bladder mucosa.
Immunity factor (15%):
The disease responds well to cortisol treatment, and some patients can detect anti-bladder mucosal antibodies in the blood. Many scholars have also found that autoimmune antibodies or immune complexes produced by vascular antigens are involved in the activation of the complement system in the vascular wall. .
Mucosal permeability change (10%):
It is speculated that IC is caused by dysfunction of bladder epithelium, its permeability increases and urine leaks into the bladder wall through the transitional epithelium, causing inflammation of the bladder. It is confirmed that the TH protein in the epithelial surface of the bladder of IC patients increases, suggesting that the mucosa is transparent. Increase in sex.
Pathogenesis
Interstitial cystitis is chronic non-specific full-thickness of the bladder. In the early stage of bladder expansion, the mucosa only sees spotted hemorrhage. In the later stage, the bladder mucosa becomes thin or necrotic and can have typical ulcers. It is more common in the top or anterior wall of the bladder, and the granulation at the bottom of the ulcer. Tissue formation, peripheral mucosal edema, vasodilatation, submucosal or muscular layer with a variety of inflammatory cell infiltration, such as plasma cells, eosinophils, monocytes, lymphocytes and mast cells, these inflammatory cells infiltrate up to the full layer of the bladder and Intermuscular nerve tissue, vascular reduction in the muscular layer, lymphatic vessel expansion, increased intramuscular and intramuscular collagen tissue, severe fibrosis leads to bladder shrinkage, severe function of the ureteral opening is severely destroyed, leading to vesicoureteral reflux and Hydronephrosis or pyelonephritis.
Prevention
Interstitial cystitis prevention
1, drink plenty of water, preferably two liters a day.
2, timely urination, do not urinate.
3, pay attention to personal hygiene, change the underwear. After the woman has urinated, use a clean toilet paper to wipe from front to back.
4. Both men and women should thoroughly clean the area before and after sexual intercourse. The urine of the bladder should be cleared immediately before sexual intercourse and after sexual intercourse.
Complication
Interstitial cystitis complications Complications, hydronephrosis, pyelonephritis, renal failure
Late stage of interstitial cystitis, bladder contracture or ureteral reflux, ureteral stricture, can cause hydronephrosis or pyelonephritis, and even renal failure.
Symptom
Interstitial inflammation of the bladder common symptoms, pain, urinary frequency, urgency, blood, urine, nocturia
For middle-aged women, severe urinary frequency, urgency and nocturia, accompanied by pain in the bladder area above the pubic bone, and normal urine examination should be considered interstitial cystitis.
(1) Symptoms: Patients often have long-term progressive urinary frequency, urgency and nocturia. When the bladder is full, the pain in the suprapubic area is obvious. Sometimes there may be pain in the urethra and perineum. It is relieved after urination, and hematuria may appear. It is obvious when the bladder is overfilled and filled, and some patients may have allergic diseases in their medical history.
(2) Signs: The clinical examination is generally normal. Some patients may have tenderness in the upper part of the pubic bone. In the female patient's anterior wall of the vagina, there may be a feeling of tenderness in the bladder area.
The diagnosis of interstitial cystitis must be based on typical clinical manifestations, cystoscopy and pathology.
In 1987, the United States established a clinical standard for the diagnosis of interstitial cystitis:
1 More than 5 times of urination at 12h during the day.
2 night urine more than 2 times.
3 symptoms lasted for more than 1 year.
4 urodynamics did not find detrusor instability.
5 bladder capacity is less than 400ml.
6 urgency.
7Hunner's ulcers incorporate at least two of the following criteria:
a pain when the bladder is full, relieved after urination.
b Under anesthesia, cystoscopy was performed, and the bladder mucosal congestion was observed 1 min at 80 cm H2O.
c The tolerance to cystoscopy is reduced, and combined with pathological diagnosis to exclude diseases similar to the clinical manifestations of interstitial cystitis.
Examine
Interstitial cystitis examination
1. Most of the urine routine is normal, sometimes with a small amount of pus cells.
2. Urine culture often has no bacterial growth.
3. Cyst angiography shows a reduction in volume and sometimes vesicoureteral reflux.
4. Cystoscopy, when the bladder is full, the pain in the suprapubic area is aggravated, and it needs to be performed under anesthesia. The bladder volume can be reduced to 50-60ml. It is found that Hunner's ulcer is helpful for diagnosis, but most patients have no ulcers. The appearance of the bladder mucosa is normal or only chronic inflammation changes, sometimes there are small bleeding points on the top. If the bladder is overfilled, the mucosal rupture and bleeding can be seen. The submucosal glomeruli (Glomeruli) are often unevenly distributed. Through the bladder, a biopsy is performed at the same time.
5. Urodynamic examination can be found that the bladder capacity is small, poor compliance, but no non-inhibitory contraction, this test helps to distinguish between interstitial cystitis and unstable bladder or neurogenic bladder.
6. Intravenous urography showed that the function and morphology of the upper urinary tract were normal.
7. Excretory urography usually has no abnormalities. In the combined reflux, hydronephrosis can be seen on the angiogram, and the bladder capacity is reduced.
Diagnosis
Diagnosis and diagnosis of interstitial cystitis
diagnosis
For middle-aged women, severe urinary frequency, urgency and nocturia, accompanied by pain in the bladder area above the pubic bone, and normal urine examination should be considered interstitial cystitis.
(1) Symptoms: Patients often have long-term progressive urinary frequency, urgency, and nocturia. When the bladder is full, the pain in the suprapubic area is obvious. Sometimes there may be pain in the urethra and perineum, which is relieved after urination. Hematuria may appear. It is obvious when the bladder is overfilled and filled, and some patients may have allergic diseases in their medical history.
(2) Signs: The clinical examination is generally normal. Some patients may have tenderness in the upper part of the pubic bone. In the female patient's anterior wall of the vagina, there may be a feeling of tenderness in the bladder area.
(3) Laboratory examination: Most of the patients' urine routines are normal, and hematuria may appear. Renal function tests will change unless bladder fibrosis leads to vesicoureteral reflux or obstruction.
(4) Radiological examination: There is no abnormality in excretory urography, and hydronephrosis and bladder capacity reduction can be seen on the contrast film when combined with reflux.
(5) Device examination: cystoscopy is an important method for diagnosing interstitial cystitis. Because the bladder capacity is reduced, the patient is very painful. After the liquid bladder is dilated, the top of the bladder can be seen with small ecchymoses, bleeding, and visible. To scars, cracks or oozing.
Differential diagnosis
1. Acute cystitis: It also manifests as urinary frequency, urgency, dysuria and other bladder irritation symptoms, but often has terminal hematuria, and there are a lot of white blood cells in the urine, and bacteria can be found in urine culture.
2. Glandular cystitis: also manifested as frequent urination, urgency, dysuria and other bladder irritation symptoms, but B-ultrasound can be found in the thickening of the bladder wall or intravesical space-occupying lesions, cystoscopy can be seen in the nipple, not shallow Table ulcers, biopsy can confirm the diagnosis.
3. Bladder tuberculosis can also be expressed as a true ulcer, often involving the ureteral orifice of the renal pelvis of the tuberculosis, there may be pyuria, urinary examination can find tubercle bacilli, urography can show typical changes of kidney tuberculosis.
4. The bladder ulcer caused by parasitic diseases is similar to the manifestation of interstitial cystitis. It is usually caused by multiple males. Diagnosis can be made according to the finding of eggs in the urine or typical pathological features of the bladder.
5. Non-specific cystitis rarely occurs in bladder ulcers, pus cells and infectious bacteria in the urine, antibiotic treatment is very effective.
6. Utz and Zinke (1974) found that 20% of the men's interstitial cystitis he diagnosed was a cancer, so he emphasized the need for biopsy cytology.
