Abstract
Aims
We aimed to assess the distinct histopathological characteristics and their clinical significance between non-Hunner and Hunner interstitial cystitis/bladder pain syndrome(IC/BPS).
Methods and results
We prospectively enrolled and classified IC/BPS patients, based on cystoscopic findings, as non-Hunner type IC and Hunner type IC. Specimens obtained from the posterior wall in non-Hunner type IC cases during hydrodistension or from Hunner /non-Hunner lesions in Hunner type IC cases during transurethral resection were evaluated. Stress urinary incontinence patients with microscopic hematuria were selected as controls. Biopsy specimens were obtained from 15 non-Hunner type IC, 15 Hunner type IC, and 5 non-IC patients. Severe and moderate fibrosis was more frequently observed in non-Hunner than in Hunner type IC and non-IC cases. However, severe and moderate inflammation was more frequently observed in Hunner than in non-Hunner type IC cases. The remnant urothelium was significantly decreased in Hunner than in non-Hunner type IC and non-IC cases (p<0.05), and non-Hunner type IC cases exhibited a greater number of mast cells than Hunner type IC and non-IC cases (p=0.035). Accordingly, several fibrosis promoting genes were highly expressed in bladder tissues of non-Hunner type IC, compared with Hunner type IC. Patients with severe fibrosis showed a significantly increased urinary frequency and smaller bladder capacity as compared to those with moderate and mild fibrosis (all p<0.05).
Conclusions
Non-Hunner type IC is characterized by severe fibrosis and increased mast cell infiltration, whereas Hunner-type IC is characterized by severe inflammation and urothelial denudation in whole bladder. Fibrosis in the bladder of IC/BPS patients was correlated with increased urinary frequency and decreased bladder capacity.
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