Reassessment of patients treated for interstitial cystitis not responding to standard therapies.

Objective: Interstitial cystitis (IC) is an uncommon disease without an exi sting positive diagnosis test. Our experience has been that it tends to be overly considered, with many patients treated for long periods with several different regimes and no improvement in the exclusionary diagnosis of IC. Material and Methods: A retrospective review of patients referred to our sp ecially clinic between December 1995 and October 1998 revealed 23 patients (21 women, 2 men) who had been diagnosed with IC, and had received at least one treatment for this disease (intravesical DMSO or Heparin, Elmiron. 1-A rginine, or therapeutic hydrodistension) with little or no benefit. Our own evaluation of these patients included urinalysis, non-invasive uroflow, pa st void residual determination and office cystoscopy (all patients), fillin g cystometrogram and pressure-flow-EMG studies (21 patients), voiding cysto urethrogram (17 patients), urethal MRI (9 patients), and other studies as i ndicated. The results of our reevaluation are reported. Results: Of the 23 patients referred with a diagnosis of IC, only 4 were co nsidered to meet the diagnostic criteria as established by the National Ins titute of Diabetes and Digestive and Kidney Disease (NIDDK) after a thoroug h evaluation. One other patient did not meet the criteria but responded to medications for IC. Urethral pathology was a common finding (distal periure thral fibrosis causing obstruction in 5 patients, intraurethral wall divert iculum in 2, and chronic urethritis in 2), particularly among women with ab normal pressure flow studies during urodynamics. Conclusions: In our experience, many patients who carried the diagnosis of interstitial cystitis were found to have other causes contributing to their urinary symptoms after careful reassessment. Urodynamic studies were found to be of paramount importance in excluding the diagnosis in many cases. On the basis of our findings, we recommend or an abnormal pressure-flow relat ionship is seen during urodynamics, further investigation is warranted.