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Interstitial  Cystitis  :   Legitimacy  of the herpetic  hypothesis

 

The following clinical case  has been observed during  three periods :  1986-1993,  1993-1999  and  1999-2004,   corresponding  to three different urology  departments,  three different diagnosis  and  three different treatments,   in spite of an  always identical   histopathology.

My best acknowledgements go to my colleagues  who  conveyed orally their  data  although  they did not take part in the present publication.

There is no paper  publication  nor  video.  That is why  this clinical case is published   in extenso  and  in french ( 8 pages  HTM )  on the International network.

 

You will find  here below  the abstract  and  the conclusions  in english.

The reader  is supposed to be well aware of  medical terms and meanings.

 

 Abstract

 

The patient is a 54 years old women, farmer in Normandy. She complains of  extremely sharp bladder pain  with irradiation to bone pelvis, coccyx,  upper thighs  down  to  the legs.  Cystoscopy shows numerous mucosal ulcers  which induce the hypothesis  of interstitial cystitis.  Both superficial  and  whole bladder wall  biopsies show  granulomatous aspects  which could evoke tuberculosis but no bacteriological support was found.

Failure of  antituberculous  and  classical  intertitial  cystitis treatments  led  to evoke the  implication  of  herpes or even  zona virus, because the patient was suffering  of  recurrent   cutaneous  herpes   and  her mother  presented a  necrotic zona of the  breast.

( Years later vulvar ulcers were found to be herpetic ).  Treatment by aciclovir brought  total relief of symptoms  for two years.

Then many urinary infections turned into acute pyelonephritis  and  the  forecast   vesico-renal reflux  became  obvious  by   Technetium radioisotopes  cystopyelography.            (See : Technique)

 

Antireflux  operation  by  lower ureter  bilateral advancement  ( See : Technique )  was performed and antiherpetic treatment continued. The patient remained free of symptoms for  four more years.

 

Eventually the patient had to consult another urological service  because of  recurrent bladder pain.

The whole range of  usual drugs  and  vesical instillations  for intertitial cystitis remained unsuccessful.

 

In the following university service of urology,  diagnosis of  hyperactive bladder was  tentatively assumed. Implantation of a neuromodulating electrode  was performed  but  without any  success  while it  led  to  severe  complications when the electrode had to be removed.

 

Finally  cystectomy  with preservation of the trigone , ureteral reimplantation and  detrusor replacement  by  detubularized intestinal graft  obtained a satisfying  result  which seems stable in the final four years of this observation.

 

 

Report of  out-patients clinic,  endoscopic procedures,  histology,  isotopic diagnosis  and  operations can be found  in the french full text.

 

 

Comments and  conclusions

 

Many facts back the herpetic implicatrion  up :

 

-  facial and vulvar  ulcers

-  bladder ulcers aspect and evolution

-  antibodies against  Herpes 1 virus

-  uninterrupted  effectiveness  of aciclovir

-  dead cert recurrence of bladder pain when aciclovir was removed

-  lack of evidence of any genuine nervous disorder and failure of  neurostimulation

-  histological aspects made of  oedema,  vascular dilatation  and neogenesis, erosive and desquamative bladder ulcers,  plasmocytic and giant cells infiltrates of the chorion.

 

It must be said that no laboratory immunohistochemical  reaction was available which could bring more  scientific  evidence.  Nevertheless  intrusion of  bacteriological changes in  the viral scene, specially common in female bladder, could  blur  the pathologist.

 

 

This unique observation  of interstitial cystitis along eighteen years  cannot lead to the assertion that herpes is  the origin of the disease. 

 

My opinion is that including the herpes virus hypothesis  into the differential diagnosis panel  and  tentative treatment  are  quite legitimate .  

Moreover  inquiries  towards all the members of the herpes family,  the chickenpox  and  zona virus  or even other potentially neurotropic virus could be  well-founded.