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Video of Hunner's lesion at cystoscopy with hydrodistension
 

This section is under construction. 
Our purpose is to provide more clinical information on the patients and explanation of the videos.

Patient 1
24-year-old female with frequency and bladder pain as long as she can remember. The patient is atypical in the sense, 
that she has symptoms for 3-7 days and then a symptom-free interval of about the same length. 
Symptoms are worst during winter time.
Urodynamics: detrusor overactivity, capacity 184 ml.
Antimuscarinics without effect.
Cystoscopy under general anaesthesia: bladder capacity of 800 ml.
Morphology: normal including detrusor, but not enough for mast cell staining.

video: Jørgen Nordling

Patient 2
21-year-old female. Symptoms started 5 years ago with abdominal pain and bladder symptoms. 
She has recurrent urinary tract infections, but she also has symptoms of pain, frequency and dysuria when 
the urine is sterile.
CT-urography and cystoscopy were normal.
Treated with Gepan with good effect!
Cystoscopy under general anaesthesia: bladder capacity of 650 ml.
Morphology normal. 

video: Jørgen Nordling

Patient 3
48-year-old man. Lower urinary tract symptoms through many years. In 2005 detoriation with frequency (11-16),
nocturia (1-2) urgency and perineal pain. Functional capacity 50-300 ml.
Urodynamics: normal (low pressure-low flow (15ml/s)).
Hb, electrolytes, PSA normal, CRP<3.
Digital rectal examination: normal.
Antimuscarinics: no effect - Antibiotics: no effect.
Send back to general practioner 2007, but re-referred 2 months later.
Steroids for nasal polyps: good effect on bladder symptoms.
Cystoscopy under general anaesthesia: bladder capacity 1000 ml.
Hunner lesion.
2 months later: no symptoms except some dysuria in the beginning and ending of voiding.

video: Jørgen Nordling

Patient 4
58-year-old female. Through many years severe symptoms of bladder pain syndrome. 
Severe bladder and pelvic pain, nocturia every 15 minutes. Sitting in the toilet all day.
Voiding diary: 42 voidings per 24 hours with 13 during nighttime. Volume 25-150 ml. 
Diuresis 3000 ml.
Urinary diversion scheduled.
CT: asymmetrical bladder with thickened left wall.
Cystoscopy under general anaesthesia: bladder capacity 225 ml. 
Hunner lesions in the left side.
After 3 weeks: pain free but still bothered by frequency
After 4 months: same
After 11 months: symptoms starting to come back. New cystoscopy planned.

video: Jørgen Nordling

Patient 5
76-year-old man.
Referred 2 years ago because of nocturia and bladder pain at full bladder. Voiding diary demonstrates nocturnal polyuria.
Urodynamics: normal
Office cystoscopy: red areas in the anterior and left bladder wall
Tentative diagnosis: carcinoma in situ
Cystoscopy: selected site biopsies including the red areas. 
Morphology: no malignancy.
Send back to GP
Rereferred 5 months later for gross hematuria
Cystoscopy: red areas with fibrin deposits on the anterior and right bladder wall including the bladder top.
Cystoscopy under general anaesthesia: ecchymosis in the right side. The areas are coagulated after biopsy, but the surgeon decides to take deep biopsies for mast cells. 
Morphology: chronic infammation and detrusor mastocytosis.
After 1 month: considerable improvement in symptoms but still nocturia and pain on full bladder in the night.. Scheduled for cystoscopy for BPS, but because of symptom improvement is this first done 17 monts later.
Cystoscopy GA: Capacity 660 ml. Hunner lesions. Mast cell count 26/24.
After 3 weeks: No pain. Nocturia x 1.

Patient 6
36-year-old female. Through 6 years pain from right hip (monoarthritis). Astma and allergy to"birk". Cornea inflammation several times.
Developed urinary symptoms 3 years ago during pregnancy. 
Cystoscopy showed inflammation and ulcer. 
Morphology: inflammation. 
Treatment: silver nitrate installation with no effect.
Now referred because of intolerable bladder pain (Dept. of Rheumatology). Treatment supp. MAP (morphine-atropin) with reasonable effect.
In the outpatient clinic, the patient is started on Gepan installations and amitriptylin 90 mg/ day and gabapentin 300 mg/day with some effect.
Cystoscopy GA: capacity 800 ml. Hunner lesion. Complicated by bladder perforation.
After 1 month: pain free, nocturia x 1; still on amitriptylin.
After 3 months: no pain, no medicine.
After 15 months: recurrence of some frequency, no pain
Cystoscopy GA: bladder capacity. Inflammation around the previously treated lesions.

video: Jørgen Nordling

Patient 7
65-year-old female previously treated elsewhere. 
Since 10 years bladder pain and frequency, treated by resection of Hunner lesions. 
Frequency every 1,5 hour, also during nighttime. (visited emergency department the day before; seen here because of pain and had i.v. morphine).
Cystoscopy under general anaesthesia: bladder capacity 250 ml; Hunner's lesions and scar. 
Morphology. mast cell count 60, granulation tissue and inflammation.
After 1 month: pain free. Slept 7 hours last night. 
Followed in Sweden, where she has developed severe left kidney pain (irritable bowel?)

video: Jørgen Nordling

Patient 8 
The video shows an Hunner's lesion.
No clinical information available to date. 

video: Jørgen Nordling

CYSTOSCOPIES