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Prof. Dr. Tahir Karadeniz, Üroloji Uzmanı

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Interstitial Cystitis

It is a chronic condition especially diagnosed in young women having active sexual intercourse. It is a disease affecting 20% of women causing them feel frequent urination and pelvic pain.

The cause of interstitial cystitis (ic) is not known. Signs and symptoms may vary from person to person. Some patients may have frequent urination with mild discomfort during years while others having severe pains with a long-lasting impact on quality of life.

If it is a severe case ,patients have difficulties with maintaining daily activities and business life. The disease may progress slowly and goes on life time with intervals. Half of our patients can not work full-time while 1/3 of our patients quit job due to the discomfort they feel.

Signs and Symptoms:

  • Frequent urination often with small amounts
  • Pain during sexual intercourse
  • Chronic pain and burning in pelvis or between vagina and anus in women, even they are not urinating
  • Pain starting after 2 to 24 hours of sexual intercourse

The cause of Interstitial Cystitis?

The exact cause of ic is not known. It can happen due to allergic reasons or some other factors may contribute. For instance if there is a defect in the lining of the bladder which is called epithelium, the urine can penetrate into the muscles of the bladder and stimulate the nerves then the complaints of the patients start.

How to Diagnose Interstitial Cystitis?

  • bladder diary,
  • urine test,
  • pelvic exam,
  • cystoscopy

What is Bladder Diary?

We ask the patient to keep a bladder diary by recording the time of urination and the volume of urine pass during 24 or 48 hours. We usually prefer 48 hours of diary.

What is Cystoscopy?

This is one of the most important method for the diagnosis and performed under general or local anesthesia. We insert a tube with a tiny camera (which is called cystoscope) through the lining of the urethra and observe the real capacity of the bladder under anesthetic condition. If the capacitty is 1000-1200 ml below the normal then we reach the diagnosis.

The most important advantage of the cystoscopy is “ hydrodistention”. After the patient is numbed with an anesthetic medication we inject liquid into the bladder to strech the bladder capacity. After performing this method we observe that 80% of our patients feel better due to the streched bladder.

How to Treat İnterstitial Cystitis?

First level of treatment is oral medication:

  • patients use medicine to treat bladder inner membrane and allergy

 

Second level treatment (if the first level treatment fails):

  • Applying botox together with the medication treatment

 

Third level of treatment (if the first and second level treatments fail):

  • This is a surgical treatment which is removal of bladder. If the patient is not getting better with the first two treatment methods we perform this surgery

 

Advanced Interstitial Cystitis Treatment - Prof. Dr. Tahir Karadeniz, MD


Today I would like to talk about “Interstitial Cystitis”. This disease can be observed both in women and men but it is more prevalent in women. This disease is not fatal but it seriously decreases the life quality of people. In fact, according to a statistics in USA 1/4 of women leave work because of this disease.

We thought before that the underlying reason is “allergic reactions” but the reason still could not be found. This disease is an “autoimmune” disease likewise Hashimoto or MS. This means that the body itself attacks its their components, so in this situation the urinary bladder harms itself. The important part here is: the urine consists of what we are eating and drinking and that urine normally can not pass into deeper layers of bladder because of this disease the inner part of the bladder is compact so it not allows any passage. But according to a hypothesis about this disease; in these patients there are some microscopic holes in the inner side of the bladder where the urine accumulates and the urine infiltrates through these holes and passes through the deeper layers such as the muscle layer of the bladder. So it induces the sensitive nerve endings and pain occurs just because of it.

There are 2 fundamental things that disturb patients about Interstitial Cystitis:

1. Too much urinating: We know that there are patients which urinates 80-90 times a day.

2. Pain: They usually complain in the sitting position and even small amount of urine which is accumulated in bladder may cause incredible pain. Thats why our primary target in this situation is to enlarge the capacity of urinary bladder so that their complaints about pain will decrease.

Therefore there are some treatment steps:

1. Medication therapy: If this treatment does not response, we apply some injections to urinary bladder (botox) but this treatment is not permanent.

2. The last but most effective treatment step is to remove the urinary bladder and to create a new bladder from the intestine (orthotopic bladder). Hereby the patients can return to their normal social lifes and they can urinate like normal healthy people.

When do we remove the urinary bladder and create a new bladder (orthotopic bladder) in Interstitial Cystitis?

We are applying it when the bladder capacity is so inadequate -how can we understand it- via cystoscopy we display the bladder and if we decide that the bladder on its own can not return to its normal capacity, we suggest this treatment and the patients will relax at the end of the process.

 

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