Diagnosis of interstitial cystitis

Interstitial cystitis (IC) represents a rare and complex inflammatory bladd er condition in which diagnostics can be challenging. Strict NIH criteria f or its diagnosis were designed for research purposes. Their routine applica tion would miss large proportions of IC patients. When IC is suspected, his tory and physical exam are followed by an evaluation of long-term voiding d iaries. Large Voided volumes (functional capacity >250 cc) or longer mictur ition intervals (>2 h.),absence of nocturia or symptom-free periods reduce the likelihood of IC. Further exclusion diagnostics include urine tests (in fection),cytology (in-situ carcinoma), ultrasound (calculi, bulks, anomalie s) and urodynamics in selected cases. Bladder capacity measurements under s edoanalgesia are of limited value, since functional low-volume bladders can be mechanically extendable. Cystoscopy under general anesthesia represents the diagnostic standard procedure for IC during which 90% of IC-patients p resent with characteristic mucosal glomerulations after bladder distension. Biopsies are recommended for exclusion of malignancy. Potassium-leak testi ng plays no relevant role in routine diagnostics due to its poor sensitivit y. Similarly, complex determinations of novel IC markers (histamine, trypta se, cytokines, growth factors, substance P,nitric oxide) are of no relevanc e in clinical settings and should be restricted to research projects.