Cystoscopic anystoscopic an ystoscopic an ystoscopic an d Histopathologic istopathologic istopathologic istopathologic istopathologic Patternsatterns atterns in in Iraqi raqi Patients atients atients with with Chronic hronic hronic Cystitis /ystitis /ystitis / ystitis / Painful ainful Bladder ladder ladder ladder Syndromeyndrome yndromeyndromeyndrome


ABSTRACT:BACKGROUND:Chronic cystitis symptoms with negative cultures always represent achallenge to the urologist because of the uncertainty in etiology and heterogenous pathological findings.OBJECTIVE:To elecit the role of cystoscopy and biopsy in disclosing the different pathological patterns in our patients with chronic cystitis like syndrome and to compare them with the pathological patterns of western patients.PATIENTS AND METHODES:This study included 64 patients (40 males and 24 females) with a persistent symptom complex of supra pubic pain, dysuria,frequency and urgency (cystitis –like syndrome)for 12 months and above , in the absence of neurological and gynaeco logical findings or positive cultures.The mean patient age was 38 years (20-68ys).The mean duration of symptoms was 26 months .All patients were subjected to a full urological evaluation, cystoscopy under G/A with hydro distension , biopsy and histopathologic examination .RESULTS:The commonest cystoscopic findings were dilated vessels, sub mucosal petechial haemorrhage after hydro distension , bilharzial lesions, mucosal cracks and small polypoid masses.Histopathologic examination revealed variable lesions as chr. Inflammatory cell infiltration, Brunns nests, cystitis cystica, metaplasia , Bilharzial reaction and ova and in situ carcinoma.Most patients had more than one lesion , especially sub mucosal petechial haemorrhage associated with bilharzial lesions or in situ carcinoma.CONCLUSION:In our patients, the chronic abacterial cystitis syndrome is common in both males and females and has different pathological findings.It is therefore , different from the pattern of the syndrome found in western patients where it mainly affects females and most often in the form of interstitial cystitis .This may be attributed to the high prevalence of stone disease and bilharziasis in addition to the highly concentrated urine of our patients.We, thus , consider it mandatory to do cystoscopy and bladder biopsy for every patient presenting with chronic cystitis like symptoms