Interstitial cystitis: Situation in Italy and insight into pathogenesis, diagnosis and treatment

Interstitial cystitis (IC) is a chronic, non-bacterial, inflammatory disease of the bladder, and appears as a syndrome characterised by painful bladder symptoms, urinary frequency, nocturia, urgency and suprapubic pain with bladder filling. It is mainly found in women (90%). It initially may resemble a bacterial infection, but antibiotics have limited or no effect. About 10% of IC patients are men who may in the past have been incorrectly diagnosed as having non-bacterial prostatitis or prostatodynia. Some patients, particularly in the early stages, experience urge and frequency without experiencing pain. Patients with severe pain caused by IC cannot be cured, but their pain can be managed effectively. Diagnosis of IC is often a long and complex process, and involves exclusion of other possible disorders. Besides, the emphasis that an individual patient may place on a specific symptom is different. In general terms, the findings of the anamnesis, urodynamics, the cystoscopy determine the diagnosis of IC. The role of bladder biopsy is controversial, but it is certainly recommended if necessary to exclude other conditions. Once a diagnosis has been made, the patient should be made aware that treatment is aimed at alleviation of the symptoms. Evaluation of treatment is hampered by the spontaneous flares and remission of symptoms that are among the features of IC. Treatment is highly individual since no medication exists that is equally effective in all IC patients: IC seems to be a multi-factorial disease. Treatment may consist of one or more drugs, bladder instillations with different substances and compounds, bladder hydrodistention, different types of nerve stimulation and, only as a last resort, surgery.