Interstitial cystitis: a review of immunological aspects of the aetiology and pathogenesis, with a hypothesis.

In ̄ammation of the bladder is a common disease mainly affecting women. Patients may complain of suprapubic pain, urinary frequency and urgency with or without haematuria on repeated occasions. In many cases, urine analysis reveals white and red blood cells, while a positive bacteriological culture will con®rm an infectious cause of the cystitis. However, if the culture is negative, with or without cells, interstitial cystitis (IC) should be suspected. IC is a poorly understood syndrome that, like bacterial cystitis, occurs primarily in women. Lack of awareness of IC by the physician or the use of an inappropriate diagnostic approach may result in a lengthy period for many patients between the onset of symptoms and diagnosis of IC. IC is a chronic in ̄ammatory bladder disorder of unknown aetiology. Bladder histology, showing in®ltrates of mast cells, eosinophilic leukocytes and T lymphocytes, suggests that the disease is mediated by the immune system. The clinical association of IC with thyroid disorders and systemic autoimmune diseases such as systemic lupus erythematosus [1] and SjoÈgren's syndrome [2], has led to the hypothesis that IC may be an autoimmune disease of the bladder. However, the triggering factor that leads to disease is still unknown, as is the case with the associated autoimmune diseases. The most prevalent aetiological theories of IC are: