Clinical Implications of Glomerulation After Cystoscopic Hydrodistention in Patients With Interstitial Cystitis and Bladder Pain Syndrome

Interstitial cystitis (IC) and bladder pain syndrome (BPS) have several clinical phenotypes. However, these subtypes may have similar symptoms, such as bladder pain, frequency, urgency, and functional somatic syndrome. A global consensus has been reached that bladders with characteristic Hunner's ulcer lesions are classified as IC, whereas those without Hunner's ulcer are classified as non‐ulcer IC/BPS. To diagnose Hunner's IC, office cystoscopy without anesthesia is usually adequate for visualizing the presence of Hunner's lesions. However, the diagnostic accuracy of cystoscopic hydrodistention for non‐ulcer IC/BPS has not been validated. Cystoscopic hydrodistention can detect mucosal dysfunction and chronic inflammation over long periods. Different grades of glomerulation may develop after hydrodistention of the bladder to a pressure of 80 cmH 2 O, and the maximal bladder capacity under anesthesia can be measured. The cystoscopic characteristics of IC/BPS after hydrodistention are associated with bladder symptoms, bladder wall CT findings, inflammatory urine biomarkers, and histopathological findings in the bladder wall. Cystoscopic hydrodistention can be a useful diagnostic examination and a treatment for IC/BPS. Cystoscopic findings are associated with severe bladder inflammation, clinical symptoms, and treatment outcomes.