Reinvestigation of patients with a diagnosis of interstitial cystitis: common things are sometimes common.

Abstract

We tested the accuracy of the diagnosis and the value of each step of the diagnostic process in a group of patients undergoing reinvestigation of interstitial cystitis (IC). A total of 61 patients with a provisional diagnosis of IC underwent systematic reinvestigation by a pathway involving a thorough history and physical examination, a rigorous search for urinary infection, frequency volume records, urodynamics and cystoscopy under general anesthesia. Abnormalities detected in the course of this pathway were treated before proceeding with further investigation. The diagnosis of IC was confirmed or considered possible in only 34 cases (55%). Common alternative diagnoses included recurrent urinary tract infections, detrusor overactivity and vaginal candidiasis. Of 5 male patients only 1 was confirmed to have IC. The original diagnosis was overturned by history and physical examination (including urine cultures) in 11 cases, by urodynamic investigation in 11 and by cystoscopy in 5. While IC remains a diagnosis of exclusion, active exclusion of all possible causes of similar symptoms using a thorough investigative algorithm is imperative. Urodynamic investigation, together with a thorough history and physical examination, remains an important component of the diagnostic pathway.