CLASSIC AND NONULCER INTERSTITIAL CYSTITIS
0
1115
2
innervating cardiovascular tissue. On the other hand, ty-
6. Fall, M., Johansson, S. L. and Aldenborg, F.: Chronic interstitial
rosine hydroxylase is the rate limiting enzyme for catechol-
amine synthesis dopamine as well as norepinephrine and
cystitis: a heterogeneous syndrome. J Urol, 137: 35, 1987
. Koziol, J. A.: Epidemiology of interstitial cystitis. Urol Clin
North Am, 21: 7, 1994
7
8
21, 22
epinephrine.
Hence, alterations, such as the prominent
. MacDermott, J. P., Charpied, G. L., Tesluk, H. et al: Recurrent
interstitial cystitis following cystoplasty: fact or fiction?
J Urol, 144: 37, 1990
increase in tyrosine hydroxylase immunoreactivity in blad-
der tissue in our interstitial cystitis cases, can presumably be
interpreted as a sign of generally increased sympathetic out-
flow. This finding becomes even more interesting in light of a
9
. Messing, E. M. and Stamey, T. A.: Interstitial cystitis: early
diagnosis, pathology and treatment. Urology, 12: 381, 1978
recent report on increased tyrosine hydroxylase immunore- 10. Koziol, J. A., Adams, H. P. and Frutos, A.: Discrimination be-
activity in the locus coeruleus of cats with interstitial cystitis
tween the ulcerous and the nonulcerous forms of interstitial
cystitis by noninvasive findings. J Urol, 155: 87, 1996
1. Fall, M., Johansson, S. L. and Vahlne, A.: A clinicopathological and
virological study of interstitial cystitis. J Urol, 133: 771, 1985
2. Aldenborg, F., Fall, M. and Enerb a¨ ck, L.: Proliferation and
transepithelial migration of mucosal mast cells in interstitial
cystitis. Immunology, 58: 411, 1986
3. Gillenwater, J. Y. and Wein, A. J.: Summary of the National Insti-
tute of Arthritis, Diabetes, Digestive and Kidney Diseases work-
shop on interstitial cystitis. National Institutes of Health, Be-
thesda, Maryland, August 28–29, 1987. J Urol, 140: 203, 1988
23
like symptoms, which was observed during silent intervals.
1
This increased immunoreactivity may be a sign of increased
locus coeruleus activity, which would in turn cause increased
activity of the peripheral sympathetic nervous system. Such
increased activity in the sympathetic system of the urogeni-
tal tract may up regulate tyrosine hydroxylase enzymatic
activity and also the amount of immunoreactive nerve fibers,
1
1
24
as observed in this study and by others. Thus, the altered
pattern of peripheral sympathetic innervation in interstitial
cystitis cases may indicate increased sympathetic tone, 14. Fall, M.: Transcutaneous electrical nerve stimulation in interstitial
cystitis. Update on clinical experience. Urology, 29: 40, 1987
which could be the primary neurogenic etiology. However, at
1
5. Peeker, R., Aldenborg, F. and Fall, M.: The treatment of inter-
stitial cystitis with supratrigonal cystectomy and ileocysto-
plasty: difference in outcome between classic and nonulcer
disease. J Urol, 159: 1479, 1998
this stage it cannot be excluded from possibility that the
increase in tyrosine hydroxylase immunoreactivity merely
results from the long-standing intense pain situation and/or
severely pathological voiding pattern.
1
1
1
6. Palea, S., Artibani, W., Ostardo, E. et al: Evidence for purinergic
neurotransmission in human urinary bladder affected by in-
terstitial cystitis. J Urol, 150: 2007, 1993
7. Peeker, R., Aldenborg, F., Haglid, K. et al: Decreased levels of
S-100 protein in nonulcer interstitial cystitis. Scand J Urol
Nephrol, 32: 395, 1998
8. Vaidyanathan, S., van-Velzen, D., Krishnan, K. R. et al: Nerve
fibres in urothelium and submucosa of neuropathic urinary
bladder: an immunohistochemical study with S-100 and neu-
rofilament. Paraplegia, 34: 137, 1996
19. Gu, J., Polak, J. M., Deane, A. et al: Increase of S-100 immuno-
reactivity in the urinary bladder from patients with multiple
sclerosis, an indication of peripheral neuronal lesion. Am J
Clin Pathol, 82: 649, 1984
CONCLUSIONS
Increased tyrosine hydroxylase immunoreactivity in inter-
stitial cystitis cases indicates an altered peripheral sympa-
thetic innervation, which may be an indication of primary
neurogenic etiology. The difference in nerve density observed
after incubation with the antibody mixture between classic
and nonulcer disease supports the hypothesis that the 2
forms represent separate entities.
REFERENCES
1
. Asklin, B. and Cassuto, J.: Intravesical lidocaine in severe inter- 20. H o¨ kfelt, T., Johansson, O., Kellerth, J.-O. et al: Immunohisto-
stitial cystitis. Case report. Scand J Urol Nephrol, 23: 311,
989
chemical distribution of substance P. In: Substance P. New
York: Raven Press, pp. 117–145, 1977
1
2
3
. Fall, M., Carlsson, C.-A. and Erlandson, B.-E.: Electrical stimu- 21. Goldstein, M.: Enzymes involved in the catalysis of catechol-
lation in interstitial cystitis. J Urol, 123: 192, 1980
. Fall, M. and Lindstr o¨ m, S.: Transcutaneous electrical nerve
amine biosynthesis. In: Methods in Neurochemistry. Edited by
R. N. Ubell. New York: Plenum Press, pp. 317–340, 1972
stimulation in classic and nonulcer interstitial cystitis. Urol 22. Goldstein, M., Fuxe, K. and H o¨ kfelt, T.: Characterization and
Clin North Am, 21: 131, 1994
tissue localization of catecholamine synthesizing enzymes.
Pharmacol Rev, 24: 293, 1972
4
. Christmas, T. J., Rode, J., Chapple, C. R. et al: Nerve fibre
proliferation in interstitial cystitis. Virchows Arch A Pathol 23. Reche, A., Jr. and Buffington, C. A. T.: Increased tyrosine hy-
Anat Histopathol, 416: 447, 1990
droxylase immunoreactivity in the locus coeruleus of cats with
interstitial cystitis. J Urol, 159: 1045, 1998
5
. Hohenfellner, M., Nunes, L., Schmidt, R. A. et al: Interstitial
cystitis: increased sympathetic innervation and related neu- 24. Thoenen, H.: Trans-synaptic enzyme induction. Life Sci, 14: 223,
ropeptide synthesis. J Urol, 147: 587, 1992
1974