[Interstitial cystitis: update on pathogenesis, diagnosis, and treatment].
OBJECTIVE
Interstitial cystitis is a nosological entity of which many etiological, diagnostic and therapeutic features were unknown until recently, so that we had the objective to review new knowledge acquired during the last decade to offer an update in the disease.


METHODS
A bibliographic review on interstitial cystitis is performed with special interest in national and international authors who have experience and large case series.


RESULTS
Among the multiple etiopathogenical theories proposed in the past, the hypothesis to be highlighted, that is gaining strength, is the altered bladder urothelium permeability or hemato-urinary barrier alteration, with the aggression of toxic substances contained in urine in high concentrations like potassium. Epidemiologically, some authors think the disease is present in the population in a higher frequency than it is diagnosed, and it may be found in many women with the misdiagnosis of recurrent urinary tract infections. Regarding diagnosis, a new test is proposed to help clinical diagnosis: the potassium test, which consists in the endovesical instillation of this ion at high concentrations reproducing the symptoms. Finally, in the medical treatment it is demonstrated the efficacy of drug associations over monotheraphy (heparinoids, antihistaminic and antidepressant drugs), looking for the correction of the physiopathological abnormalities caused by the disease. Psicologic support and continuous information to the patient about the disease continue to be one of the mainstays of this multimodal therapy. New options like neural stimulation have appeared, although its results are not conclusive so that further studies must be done.


CONCLUSIONS
New knowledge about interstitial cystitis allow us to better understand the chain of events happening in it. An early clinical diagnosis, now reinforced with a positive potassium test, is key to start medical treatment (drug combination) targeted to stop the pathogenic process, because it is more effective in the early phases of the disease. For that purpose, the Urologist must have this disease in mind.
Cózar Olmo
Jose Manuel
JM
Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, España.
Martínez Morcillo
Antonio
A
Vicente Prados
Javier
J
Tallada Buñuel
Miguel
M
Espejo Maldonado
Eduardo
E
D018856:Cystitis, Interstitial / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans