End-stage bladder develops quickly in most patients

Key Points

New York-Does milder interstitial cystitis progress to an inevitable bad end with no apparent option but diversion? No, believes Jerry Blaivas, MD, who took a close look at cases with "end-stage" bladder seen at his institution over the past decade. By looking at the natural history of these cases, he aimed not only to determine whether cases of painful bladder syndrome progress this far but also to look for what might cause these severe cases and determine what treatment is appropriate.

Patients also had to show no evidence of malignancy and have had no pelvic radiation. (One patient was included who had undergone three bladder biopsies with negative results but turned out to have a poorly differentiated bladder carcinoma.)

All of the patients had pyuria and microhematuria and marked inflammation on every cystoscopy. They all had marked urinary frequency, bladder capacities were tiny, and compliance was low (means of 20 voids per day, 120 mL maximum voided volume, 173 mL cystometrogram bladder capacity, and 8 mL/cm H₂O bladder compliance, respectively).

Not only was bladder compliance low for 20 patients (75%), but nine (36%) also had vesicoureteral reflux, 14 (56%) had hydronephrosis, and eight (32%) had renal failure.