Increased tyrosine hydroxylase immunoreactivity in bladder tissue from patients with classic and nonulcer interstitial cystitis

Purpose: Interstitial cystitis is a chronic debilitating condition which ma inly affects women. Accumulated evidence indicates that interstitial cystit is is a heterogeneous syndrome. The nonulcer subtype appears different than classic interstitial. cystitis in regard to symptoms, and endoscopic and h istological findings as well as response to various treatments. We further explore the neurogenic nature of this disease using indirect immunofluoresc ence to evaluate the presence and density of various autonomic and sensory nerve fibers. Materials and Methods: Specimens from the bladder wall of 6 patients with c lassic interstitial cystitis, 7 with nonulcer interstitial cystitis and 6 c ontrols were evaluated to determine the presence and density of nerve fiber s containing tyrosine hydroxylase, calcitonin gene-related peptide, neurope ptide Y and substance P using specific antibodies, and the general presence of nerve fibers using a mixture of antibodies against nerve filament, neur on specific enolase and S-100 protein. Results: Increased density and number of nerve fibers immunoreactive for ty rosine hydroxylase were noted in interstitial cystitis cases compared to co ntrols. Furthermore, there was a difference between classic and nonulcer di sease in the overall density of nerves using the antibody mixture. Conclusions: Our findings indicate an altered peripheral sympathetic innerv ation in interstitial cystitis cases, which may be an indication of primary neurogenic etiology. The difference in nerve density observed after incuba tion with the antibody mixture between classic and nonulcer interstitial cy stitis supports the hypothesis that the 2 forms represent separate entities .