A PROSPECTIVE-STUDY OF MICROORGANISMS IN URINE AND BLADDER BIOPSIES FROM INTERSTITIAL CYSTITIS PATIENTS AND CONTROLS

Objectives. Interstitial cystitis (IC) is a chronic inflammatory condi tion of the bladder of unknown etiology. We tested the hypothesis that a microorganism would be found at higher prevalence in urine or bladd er tissue from women with IC than from control women. Methods. Urine a nd bladder tissue were obtained at cystoscopy from 11 IC patients and 7 control subjects. These specimens were cultured for a variety of fas tidious and nonfastidious bacteria, mycobacteria, fungi, and viruses. In addition, special staining techniques were used to examine biopsy s pecimens and cytospun urine, and tissue sections and outgrowths of exp lanted bladder cells were examined by electron microscopy. Results. Cu ltures of urine from 6 of 11 IC patients grew five different bacteria (Corynebacterium sp, Klebsiella pneumoniae, Lactobacillus sp, Streptoc occus constellatus, and Streptococcus morbillorum), human cytomegalovi rus, or Torulopsis glabrata; one of these organisms (Lactobacillus sp) was found in urine from 2 patients. Although contamination by urethra l organisms is possible, the prevalence of microorganisms in urine of IC patients (6 of 11) was significantly greater than in urine of contr ol subjects (0 of 7) (P < 0.05). Acridine orange staining revealed rod s with appropriate morphology in urine from 4 of the 5 IC patients who had positive bacterial cultures and yeastlike organisms in urine and bladder tissue specimens that grew Torulopsis. Additionally, rodlike o rganisms were seen in urine from 2 IC patients with negative bacterial cultures and cocci were seen in the urine of 1 control patient. Biops y specimens from 2 IC patients grew Torulopsis sp or Lactobacillus sp, in agreement with the results of acridine orange staining and culture of urine from these patients; in contrast, specimens from 3 control s ubjects grew small numbers of Pseudomonas sp or Staphylococcus epiderm idis, but no organisms were cultured from urine or seen in acridine or ange-stained tissue smears. All other cultures and stains were negativ e. Conclusions. These data do not provide evidence that IC is associat ed with infection or colonization by a single microorganism. However, they do generate the hypothesis that the prevalence of microorganisms, especially bacteria at low concentrations, is greater in the urine of IC patients than of control subjects. If these results are confirmed by other controlled studies, the question of whether the presence of t hese organisms is a cause or a result of IC should be addressed.