間質性膀胱炎在膀胱水擴張術後的不同特徵與電子顯微鏡下的差異

李宇坤、張嘉峰、郭漢崇

花蓮慈濟醫院 泌尿部

Difference of electron microscopic findings in IC/BPS with different cystoscopic characteristics following hydrodistention

Yu Khun Lee, Jia-Fong Jhang, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan

Purpose:

Urothelium dysfunction is considered a key pathological mechanism of interstitial cystitis/bladder pain syndrome (IC/BPS). This study investigated the difference of electron microscopic (EM) findings in IC/BPS patients with different bladder characteristics.

Materials and Methods:

A total of 100 IC/BPS patients were enrolled and 24 with stress urinary incontinence as controls. Clinical symptoms were evaluated with Visual Analog Scale (VAS) and O'Leary-Sant symptom score (OSS). Cystoscopic hydrodistention followed by bladder biopsies were obtained and investigated with EM. The presence of Hunner lesion and the grade of glomerulation after hydrodistention were recorded. The EM findings between IC/BPS patients with different cystoscopic characteristics and controls were compared.

Results:

The urothelium of Hunner-type IC (HIC) patients had more severe defects of the urothelium cell layers, defects in integrity of umbrella cells, loss of umbrella cell surface uroplakin plaque, and loss of tight junction between adjacent umbrella cells, than control and non-Hunner-type IC (NHIC) groups (p=0.004, p=0.001; p=0.013, p=0.008; p=0.001, p=0.000; p=0.018, p=0.012, respectively). Both NHIC and HIC groups had more severe lamina propria inflammatory cells infiltration than control group (p=0.011, p=0.000, respectively). The patients with severe defects of the urothelium cell layers had significantly higher OSS (p=0.030).

Conclusions:

EM findings of HIC bladder had significantly more severe urothelial defects than NHIC. Suburothelial inflammatory cells infiltration was common in HIC and NHIC patients with high grade glomerulation. The urothelium cell layers defects on EM were associated with clinical symptom severity.