RELATIONSHIPS BETWEEN BLADDER INFLAMMATION AND OTHER CLINICAL-FEATURES IN INTERSTITIAL CYSTITIS

Objectives. Interstitial cystitis (IC) has been considered possibly to represent more than one disease process. If so, patients would be exp ected to form distinct subgroups. The degree of mononuclear inflammati on on bladder biopsy can be objectively quantified and might be a usef ul parameter for subgroup division. The hypothesis of this study was t hat patients with mild versus severe inflammation would differ with re gard to other clinical features of IC. Methods. Sixteen patients who m et the original National Institute of Diabetes, Digestive and Kidney D iseases criteria for IC underwent cystoscopy with bladder distention a nd biopsy. The degree of mononuclear inflammation on bladder biopsy wa s classified as mild, with less than 100 mononuclear cells/high power field (HPF), or severe (100 or more mononuclear cells/HPF or lymphoid aggregates). Associations were sought between degree of inflammation a nd other subjective and objective clinical features. Results. Five pat ients had severe inflammation and 11 had mild inflammation. The major finding was that the patients with severe inflammation experienced bet ter symptom relief after cystoscopy with bladder distention under anes thesia. This difference was highly significant (Fisher's exact test, p = 0.0014). For the other clinical features studied, these two groups did not differ significantly. Conclusions. Two distinct IC patient gro ups were identified by bladder biopsy findings. These two groups had s ignificantly different treatment responses. If this difference is conf irmed with a larger number of patients, it would suggest that these tw o patient groups may have different underlying disease processes.