The role of cystoscopy in the diagnosis of Hunner's ulcer disease.

PURPOSE

Interstitial cystitis can be classified into Hunner's ulcer and nonulcer disease, which are easily distinguished by cystoscopic examination. Although therapeutic options may differ between these 2 groups, the diagnosis of interstitial cystitis is currently established by many clinicians in the absence of cystoscopy. We determined whether clinical parameters alone without cystoscopic evaluation could reliably distinguish the patient with Hunner's ulcer vs nonHunner's ulcer disease.

MATERIALS AND METHODS

Data were collected on 184 women and 39 men who met National Institute of Diabetes, Digestive and Kidney Diseases criteria for interstitial cystitis and who were evaluated at our institution between 1990 and 2005. A total of 86 patients with Hunner's ulcer were consecutively identified. Of patients with nonHunner's ulcer disease seen during that period a cohort of 137 who were consecutively identified were selected as a comparison group. Clinical data on each patient were collected. The groups were compared by the 2-sample t test, the Mann-Whitney test when appropriate and the chi-square test.

RESULTS

No significant differences in clinical parameters were found between women and men in either group. The female-to-male ratio was 6:1 and 3:1 in the nonHunner's and Hunner's ulcer groups, respectively. The mean age of patients with Hunner's ulcer was significantly higher than that of patients with nonHunner's ulcer disease (60 vs 47 years, t test p <0.001). No significant differences in symptom duration, history of gross hematuria, history of comorbid disease or visual analog pain scores were found between the 2 groups. Microscopic hematuria was present in 27 (31%) and 29 patients (21%) with Hunner's ulcer and nonHunner's ulcer disease, respectively (chi-square test p <0.086).

CONCLUSIONS

Although there have been recently published methods and markers by which to differentiate Hunner's ulcer vs nonHunner's ulcer interstitial cystitis, our data demonstrate that standard clinical evaluation cannot reliably distinguish these groups. These findings suggest that cystoscopy is needed to accurately identify patients with Hunner's ulcer.