UTI Case scenario

J.D, a 26 year old female, presents to the urology clinic for the first time. She was referred by the primary health care provider for recurrent urinary tract infection with gross haematuria. Her presenting complaint includes a four week (4/52) history of urinary frequency and urgency, lower abdominal pain, intense vaginal pain (worse during intercourse). She reports that she has a history of inflammatory bowel disease, seasonal allergies and is on anxiolytics due to her stressful personal life. She reports occasional lightheadedness and fatiguability. Her diet consists of very little vegetables, a lot of spicy, fried foods and has coffee five times daily. She has three sexual partners.

J.D brought a letter from her referring doctor stating that her urinalysis with MCS (microscopy, culture and sensitivity) have always been negative; she has been treated with fluconazole 150mg po (OD) STAT and a 14 day course of fluconazole, without resolution of symptoms. A KUB ultrasound and X-ray was unremarkable. The urologist recommended a CHB (cystoscopy with hydrodistension of bladder) under anaesthesia with biopsy. She is counseled that although CHB is a same-day procedure, she
will be warded for one day for monitoring of symptoms of acute urinary retention following the CHB. A CBC and RFT is done.

On examination:

Vital signs: BP 120/78, Pulse 110, Spo2 100%, Respiration Rate -18.
Abdominal exam: soft, tenderness in Supra pubic region ++ with guarding, no rebound tenderness, no renal angle tenderness was elicited, no masses palpable, normal bowel sounds.

Cardiovascular, respiratory, musculoskeletal, central nervous system examinations were unremarkable.

CBC:
WBC 16×10^9 mg/dL
Hb 10.1

RFT:
Na 135 mEq/L
Cl 100 mEq/L
Creatinine- 0.8

Why might a Biopsy be indicated if a diagnosis of interstitial cystitis is suspected?

UTI Case scenario

J.D, a 26 year old female, presents to the urology clinic for the first time. She was referred by
the primary health care provider for recurrent urinary tract infection with gross haematuria.
Her presenting complaint includes a four week (4/52) history of urinary frequency and
urgency, lower abdominal pain, intense vaginal pain (worse during intercourse). She reports
that she has a history of inflammatory bowel disease, seasonal allergies and is on anxiolytics
due to her stressful personal life. She reports occasional lightheadedness and fatiguability.
Her diet consists of very little vegetables, a lot of spicy, fried foods and has coffee five times
daily. She has three sexual partners.

J.D brought a letter from her referring doctor stating that her urinalysis with MCS
(microscopy, culture and sensitivity) have always been negative; she has been treated with
fluconazole 150mg po (OD) STAT and a 14 day course of fluconazole, without resolution of
symptoms. A KUB ultrasound and X-ray was unremarkable.
The urologist recommended a CHB (cystoscopy with hydrodistension of bladder) under
anaesthesia with biopsy. She is counseled that although CHB is a same-day procedure, she
will be warded for one day for monitoring of symptoms of acute urinary retention following
the CHB. A CBC and RFT is done.

On examination:

Vital signs: BP 120/78, Pulse 110, Spo2 100%, Respiration Rate -18.
Abdominal exam: soft, tenderness in Supra pubic region ++ with guarding, no rebound
tenderness, no renal angle tenderness was elicited, no masses palpable, normal bowel
sounds.

Cardiovascular, respiratory, musculoskeletal, central nervous system examinations were
unremarkable.

CBC:
WBC 16×10^9 mg/dL
Hb 10.1

RFT:
Na 135 mEq/L
Cl 100 mEq/L
Creatinine- 0.8

Question:

Why might a Biopsy be indicated if a diagnosis of interstitial cystitis is suspected?