REPLY BY AUTHORS
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FLUORESCEIN ANGIOGRAPHY OF BLADDER 65 12. Irwin, P. and Galloway, N.: Abnormal bladder perfusion in in- terstitial cystitis. A study using laser Doppler flowmetry. Neurourol. Urodynam., abstract 77, p. 418, 1992. EDITORIAL COMMENT As a preliminary report on the use of fluorescein angiography for interstitial cystitis, this appears to be intriguing but the authors let the patients act as their own controls. I believe that hydrodistension in normal subjects followed by fluorescein angiography for compar- ison would be necessary to recognize the true use of this technique in patients with suspected interstitial cystitis. It also would have made the suppositions and conclusionsconcerningfluorescein angiography in interstitial cystitis more believable to me if the authors would have been able to show photographs to support the statements made regarding interstitial cystitis. After all, this technique is known to be useful for bladder cancer already and we are always looking for something (anything) that may help the urologist distinguish true interstitial cystitis h m other causes of the painful bladder. Finally, the discussion of heparin release from mast cells, and its relation to interstitial cystitis and this presumed diagnostic process is not supported. Mast cells release many chemicals on degranula- tion and if heparin is involved in the pathogenesis of interstitial cystitis then perhaps we should not be using it to 'repair" the glycosaminoglycan layer (as those who believe that interstitial cys- titis is due to defects in the glycosaminoglycan layer recommend) any more than we would think to use histamine (another chemical re- leased from mast cells and believed to be involved in the etiology of interstitial cystitis). In my view this article supports the use of fluorescein angiography in the evaluation of bladder cancer without adding much to the confusing diagnostic and therapeutic dilemma with respect to interstitial cystitis. Rodney A. Appell Department of Urology Cleveland Clinic Cleveland, Ohio REPLY BY AUTHORS Our study was not intended to add another dilemma relating to interstitial cystitis. However, we hoped to gain some knowledge of the glomerulations observed aRer hydrodistension in interstitial cys- titis patients. Hydrodistension in normal controls followed by fluo- rescein angiography would have been the ideal scenario but the risks of hydrodistension were considered too serious in healthy individu- als. Since all interstitial cystitis patients had diffuse glomerulations precluding their use as controls, the normal areas of bladder wall in our bladder tumor patients legitimately served as controls. To our knowledge fluorescein angiography has never been previously re- ported for study of human bladder wall vasculature. The important message of this preliminary investigation relates to the origin of the glomerulations appearing in the venular phase and not corresponding to "leaky" vessels. What these glomerulations represent in the pathogenesis of interstitial cystitis remains coqjec- tural. This simple technique may be useful to evaluate objectively the bladder blood flow and further investigate the ischemic etiology of interstitial cystitis.
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Transcript of REPLY BY AUTHORS
FLUORESCEIN ANGIOGRAPHY OF BLADDER 65 12. Irwin, P. and Galloway, N.: Abnormal bladder perfusion in in-
terstitial cystitis. A study using laser Doppler flowmetry. Neurourol. Urodynam., abstract 77, p. 418, 1992.
EDITORIAL COMMENT
As a preliminary report on the use of fluorescein angiography for interstitial cystitis, this appears to be intriguing but the authors let the patients act as their own controls. I believe that hydrodistension in normal subjects followed by fluorescein angiography for compar- ison would be necessary to recognize the true use of this technique in patients with suspected interstitial cystitis. It also would have made the suppositions and conclusions concerning fluorescein angiography in interstitial cystitis more believable to me if the authors would have been able to show photographs to support the statements made regarding interstitial cystitis. After all, this technique is known to be useful for bladder cancer already and we are always looking for something (anything) that may help the urologist distinguish true interstitial cystitis h m other causes of the painful bladder.
Finally, the discussion of heparin release from mast cells, and its relation to interstitial cystitis and this presumed diagnostic process is not supported. Mast cells release many chemicals on degranula- tion and if heparin is involved in the pathogenesis of interstitial cystitis then perhaps we should not be using it to 'repair" the glycosaminoglycan layer (as those who believe that interstitial cys- titis is due to defects in the glycosaminoglycan layer recommend) any more than we would think to use histamine (another chemical re- leased from mast cells and believed to be involved in the etiology of interstitial cystitis). In my view this article supports the use of
fluorescein angiography in the evaluation of bladder cancer without adding much to the confusing diagnostic and therapeutic dilemma with respect to interstitial cystitis.
Rodney A. Appell Department of Urology Cleveland Clinic Cleveland, Ohio
REPLY BY AUTHORS
Our study was not intended to add another dilemma relating to interstitial cystitis. However, we hoped to gain some knowledge of the glomerulations observed aRer hydrodistension in interstitial cys- titis patients. Hydrodistension in normal controls followed by fluo- rescein angiography would have been the ideal scenario but the risks of hydrodistension were considered too serious in healthy individu- als. Since all interstitial cystitis patients had diffuse glomerulations precluding their use as controls, the normal areas of bladder wall in our bladder tumor patients legitimately served as controls. To our knowledge fluorescein angiography has never been previously re- ported for study of human bladder wall vasculature.
The important message of this preliminary investigation relates to the origin of the glomerulations appearing in the venular phase and not corresponding to "leaky" vessels. What these glomerulations represent in the pathogenesis of interstitial cystitis remains coqjec- tural. This simple technique may be useful to evaluate objectively the bladder blood flow and further investigate the ischemic etiology of interstitial cystitis.
