Interstitial Cystitis (Books) [Hardcover]

Sant (Author), Grannum R. Sant (Editor)

Book Description

ISBN-10: 0397516959 | ISBN-13: 978-0397516957 | Publication Date: January 1997

This definitive text is edited by the leading expert on this complex and poorly understood topic, with international authors from the following fields: urology, pathology, immunology, pharmacology, psychology, nursing, biostatistics, and veterinary medicine. The book includes major sections on Historical/Epidemiologic Issues , including the history, epidemiology, and IC database study; Research , including animal models, autoimmune correlates, inflammation, infection, diet, urinary markers, and more; Diagnostic Options , including clinical and endoscopic features, pathology, gynecologic aspects, IC in men, and urodynamic evaluation; Treatment Options , including oral and laser therapies, pain management, electrical stimulation, surgery, intravesical therapies, and more; and General Issues , including a woman's health perspective, quality of life issues, and a unique IC Symptom and Problem Index

Editorial Reviews

From The New England Journal of Medicine

For over a hundred years, interstitial cystitis has remained a multifaceted and enigmatic syndrome characterized by variable motor and sensory dysfunction of the bladder. The diagnosis is usually based on symptoms, a urologic evaluation including cystoscopy, and the exclusion of other recognizable bladder diseases. The most common symptoms are urinary frequency and urgency and suprapubic, pelvic, or perineal pain. The initial description of interstitial cystitis by Hunner was of a solitary ulceration of the bladder, but this presentation is rare; the majority of affected patients have bladders with strawberry-like hemorrhages on distention that are commonly referred to as glomerulations.

Because of the high incidence of interstitial cystitis in the United States, which has been estimated to be 2.6 per 100,000, and the substantial social and economic costs of the disease, the National Institute of Diabetes and Digestive and Kidney Diseases initiated the Interstitial Cystitis Database Study in early 1991 to advance the knowledge of the disease and to define its history and treatment more clearly. By 1995, 377 patients were enrolled in the study. They were predominantly female (91 percent) and middle-aged (50 percent were 35 to 54 years of age).

In Interstitial Cystitis, Sant and his coauthors present a thorough and multidisciplinary review of current research and of the diagnostic and treatment options that are available. The causes of interstitial cystitis are unknown but may include bacteria, viruses, toxic substances in the urine, physical trauma to the bladder wall, and bladder-specific autoimmune disease. By definition, patients with interstitial cystitis cannot have symptoms related to common bacterial pathogens. The possibility of occult infection has been evaluated by Domingue, who used the polymerase chain reaction to identify bacterial DNA sequences in bladder-biopsy specimens from affected patients. Although his initial studies identified bacterial DNA in over one third of the patients, subsequent investigators have failed to detect viral or bacterial DNA, suggesting that the initial studies may have identified contaminants.

Another hypothesis is that the relatively impermeable urothelium lining (the glycosaminoglycans layer) is impaired as either a cause or a result of interstitial cystitis and that leakage of urine aggravates the underlying neuromuscular layer. Efforts to replace the glycosaminoglycans layer with heparin-like substitutes appear to have promise. The possibility that an initial inflammatory event is reinforced by neurogenic mechanisms, resulting in changes in neuroprocessing, pain pathways, and perturbations in the function of the peripheral nervous system that outlast the initial event, is intriguing and nicely ties together several aspects of the aforementioned hypotheses. Other hypotheses implicating mast cells and mucosal immunity are also intriguing.

The authors correctly emphasize that in the assessment of patients with potential interstitial cystitis, it is helpful to keep in mind that this is a symptom complex and that there are no pathognomonic findings associated with the disease. The onset of symptoms is usually acute, and symptoms may be present for several years before the patient is evaluated. Periods of exacerbation are followed by spontaneous remissions. The results of abdominal, pelvic, and neurologic examinations are nonspecific and often unremarkable. Other possible causes of the patient's symptoms, including infection and neurologic disorders, must be ruled out. Only cystoscopy with the patient under anesthesia can sufficiently distend the bladder to afford visualization of glomerulations and Hunner's ulcers. Biopsies and cytologic analysis are nonspecific but imperative to rule out carcinoma in situ.

The final chapters of the book provide practice guidelines and measurements of the health-related quality of life that will help clinicians determine which patients will require medical or surgical management. Therapy is empirical and directed at the patient's symptoms. Amitriptyline, one of the tricyclic antidepressants, has become widely used as an oral therapy for interstitial cystitis. Hydrodilation of the bladder and intravesical instillations of oxychlorosene sodium or dimethyl sulfoxide appear to be effective. Procedures to manipulate the innervation of the bladder, augmentation of the bladder, and ultimately, cystectomy should be reserved for intractable cases.

This book is an excellent resource for medical providers who are confronted with the challenging task of identifying, evaluating, and caring for patients with interstitial cystitis.

Reviewed by Anthony J. Schaeffer, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Product Details

• Hardcover: 304 pages
• Publisher: Lippincott Williams & Wilkins (January 1997)
• Language: English
• ISBN-10: 0397516959
• ISBN-13: 978-0397516957
• Product Dimensions: 11.1 x 8.6 x 0.8 inches
• Shipping Weight: 2.3 pounds
• Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #986,456 in Books (See Top 100 in Books)

Customer Reviews

Most Helpful Customer Reviews

9 of 9 people found the following review helpful:

5.0 out of 5 stars An excellent resource for IC physicians & clinical staff, October 28, 1998

By A Customer

This review is from: Interstitial Cystitis (Books) (Hardcover)

Grannum Sant's "Interstitial Cystitis" is an excellent resource for clinicians and patients seeking academic/research oriented information on IC treatments, pathology, epidemiology and much more! Contents include discussions on the history of IC, current research, diagnostic options, a wide variety of treatments and general issues, such as quality of life.

Of particular note is the insightful chapter "The Causes and Treatment of Pain in Interstitial Cystitis" written by Daniel Brookoff, MD, which has helped us convey the often underestimated need for pain management.

This book is a cornerstone to any IC library, including our own at the IC Network. Very well done and much appreciated by the patient community.

5.0 out of 5 stars Every Urologist and IC Patient Should Memorize This Book!, January 24, 2012

By 

Honestly - See all my reviews

This review is from: Interstitial Cystitis (Books) (Hardcover)

Most physicians are almost completely ignorant to the various aspects of and treatments for this disease. They should be ashamed! This book is a good beginning to developing an understanding. Interstitial Cystitis can be an absolutely devastating illness, robbing some patients of virtually any ability to enjoy life at all, wishing that life would end just to end the pain. Gnawing away not just at the bladder but at the psyche as well, it feels as if it's going to drive you insane. No other pain that I have experienced has a similar component. Simultaneously. it feels as if the lining of the bladder has been scraped raw with a razor and lemon juice has been poured over the surface. I've read that studies have been done with rodents which, when having had this disease induced, tried to eat their bladders out of their little bodies. I know just how those little critters felt!

Some have less severe symptoms and should consider themselves blessed if they can lead lives of any normalcy. Some of us void 45 to 70 times a day and voiding only slightly decreases the pain. We wake too often to achieve REM sleep, which affects the body and mind very negatively to say the least. Patients with IC are much more likely to have IBS, Fibromyalgia, Migraine Headaches, Rheumatoid Arthritis and to be Depressed. Restrictions to diet and stress can help but many have to resort to the use of very high doses of pain medication just to reduce the pain level and to endure this illness. These medications have side-effects. Depression is one of these side effects so we have a "double dose" degree of likelihood of becoming severely depressed. All of these illnesses and side effects must be managed concurrently by the patient and their physicians. This book is a great basis for the knowledge necessary to do this. Patients, their loved ones, Family Practitioners, Urologists and pain specialists really should be well acquainted with this text. It is the best and most thorough that I have read in my 35 years of experience with the illness.