The diagnosis of interstitial cystitis.

The diagnosis of interstitial cystitis can be firmly established by evaluating symptoms and history carefully, ruling out other diseases which can mimic its clinical picture, and performing the necessary cystoscopic examination (almost always under anesthesia). We also advocate that biopsy be performed in all individuals; although, since no pathognomonic abnormalities are demonstrable, it is unclear if the diagnosis of interstitial cystitis can be established or excluded by biopsy alone (unless, of course, another disease is encountered). While urodynamic studies are primarily useful to rule out interstitial cystitis, they may, in addition, have a role in subsequent management and/or in assessment of therapeutic response and thus, at least simple cystometry should probably also be performed. However, more complex urodynamic (e.g., electromyography, urethral pressure profilometry, etc.), radiographic (e.g., intravenous urography, voiding cystourethrography, or computerized axial tomography), laboratory or surgical (e.g., laparoscopy, prostate biopsy) studies are of minimal value in diagnosing interstitial cystitis and should only be done in the face of clinical evidence indicating their appropriateness.