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Interstitial Cystitis
The interstitial cystitis (IC) is an illness where the bladder has bigger sensibility that in normal situation.

In some cases it can be associated with the inflammation of the bladder wall. The symptoms usually include the need to urinate frequently due to the growing discomfort or pain in the pelvis. Many patients with chronic pelvic pain have this discomfort and, in fact, in the evaluation it also shows that the IC is present in the Syndrome of chronic pelvic pain.

  Litiasis renal

General description
The diagnosis is based fundamentally on the exclusion of other type of illnesses that affect the bladder like infection, cancer, etc. It frequently affects women, but it is not strange that men suffer it.
The symptoms of the IC:
Increased urinary frequency 
Urgency to urinate. Sudden desire to urinate 
Pelvic pain or discomfort. When the bladder is empty or full  
Pain associated with sexual relations  
The symptoms worsen with food and different drinks  
Other existent problems, as allergies, irritable bowel syndrome, fibromyalgia, skin sensibility, and the vulvodynia (vulva pain) 
 
Hesitation or interruption of the flow of the urine  
Constipation
The sensation of wanting to keep urinating 
The symptoms that vary with the menstrual cycle

IC / PBS there are two main categories:
"Classic". Associated with visible inflammation of the bladder wall
"Non classic" of the illness. The patients with this condition have many symptoms, but the exam of the surface of the bladder doesn't show the evident inflammation


What will we do if you ask for advice about interstitial cystitis?
We will do a detailed clinical history and a physical examination. This is the most important part of your visit; it provides a vision of all tests resulting in orientation to know what therapies will probably be useful. The patients often have been evaluated by many doctors in the past. It is necessary to bring any test made in the past.

Laboratory tests: they can include a urine analysis, a urine cultivation, blood tests (including the prostate-specific antigen) and in some cases, a urine cytology (an exam to detect cancerous cells in the urinary tract). A "prostate massage" can be carried out during the physical examination. This procedure is a little uncomfortable, since it implies to press the prostate during a digital.rectal exam. The seminal liquid obtained in this examination or in the urine, obtained after the examination, can give hints for your diagnosis. Surprisingly, some patients feel a significant relief from the symptoms after this procedure.

Other tests recommended, include:

Tests to detect sexual transmission diseases
Evaluation of the voiding of the bladder. It is usually carried out with a simple ultrasound in the clinic
The urodynamic evaluation. This is a test that evaluates the function of the bladder and it can also provide information about the muscles of the pelvic floor
Cystoscopy. This procedure consists on passing a flexible device with a lens, through the urethra toward the bladder. The cystoscopy can provide information about the inflammation, scars, cancer, calculus in the bladder or prostate growth
Ultrasound tests. They can include prostate, scrotum and / or kidneys echography
TAC or magnetic resonance of abdomen and / or pelvis


Treatment options
The Treatment of the IC is individualized for each patient and it is based mainly on the diagnosis and on the tolerance to administered medications or other required therapies. The treatments are, therefore, very varied. These can include:
Changes in the diet
Modification of the behavior
Therapy with antibiotics, anti-inflammatories, anesthetics for the urinary tract, alpha blockers and antiespasmodic agents for the bladder, muscle relaxant, antihistamine drugs, anticonvulsory agents, antidepressant therapy (many agents in this group are suitable for "neuropathic pain") ,atypical opioids, Narcotics therapy (in general, given by pain treatment centers), Physical Therapy, Injection to the affected muscular group, pudendal nerve blocking.
The neuromodulation
BOTOX ® injection
Urethral suppository
Fulguration (to burn with laser or electric current) of the lesions of the bladder
The surgical reconstruction


Fulguration of the lesions of the bladder
Fulguration of the bladder ulcers is usually carried out to diminish the pain. 
  
The concept of fulguration of the ulcers is to destroy the local nerves and to decrease the substances which cause the inflammation. The Fulguration is generally carried out with general anesthetizes or raquianestesy since most of the patients cannot tolerate the discomfort of the filled bladder. A special lens called endoscope is used to carry out the procedure through the urethra, inside the bladder. It is recommended to take a biopsy of the bladder previously, so we will use it to evaluate the inflammation or to discard cancer.

Hydrodistention
The Hydrodistention of the bladder is a procedure which is frequently carried out to help to establish a diagnosis of the interstitial cystitis. Hydrodistention literally means to loosen the bladder with water. A liquid is introduced in the bladder to a certain and relatively high pressure (80-100 cm of H20). When the water is liberated from the bladder, the patients with interstitial cystitis typically develop small dots of blood under the surface of the bladder, called "glomerulations". The Hydrodistention is carried out with general anesthetizes or raquianestesy since most of the patients cannot tolerate the discomfort of the filled bladder. When the test finishes, the liquid is eliminated by the same endoscope that was introduced.

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