Recent developments in the management of interstitial cystitis

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Abstract
Interstitial cystitis, a great enigma of urology today, is a chronic sterile inflammatory disease of the bladder of unknown etiology characterized by urinary frequency, urgency, nocturia and suprapubic pain. Although there are plenty of theories, the etiology of the condition remains obscure. This review focuses on recently published literature on interstitial cystitis. Several pathophysiological mechanisms have been proposed in the past few years including epithelial dysfunction, activation of mast cells, neurogenic inflammation, autoimmunity and occult infection. Evidence indicates that it is a heterogeneous syndrome and that the two subtypes, classic and nonulcer disease, represent different entities. The diagnosis is made by clinical and cystoscopic evaluation with hydrodistension and often with biopsy when other disorders are excluded. The National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases has developed criteria for clinical studies. There is a need for a noninvasive marker of interstitial cystitis. Antiproliferative factor as a urinary marker has shown promising results. The value of the bladder permeability test in interstitial cystitis needs further investigation. Many gynecologic conditions mimic the symptoms of interstitial cystitis. Multiple forms of therapy are available including self-care and dietary changes, medical and intravesical treatments, neuromodulation, multimodality treatment and surgical intervention. It is recommended that the most conservative treatments are used first and surgery should be regarded as the last resort. Interstitial cystitis is a challenging disease of urology today. While causative factors remain unknown, treatment is based on empiricism. Intensive research may result in new and hopefully more effective treatments in the future.