 Pelvic pain and dyscomfort  Frequent urination  Urge symptoms  Negative urine test  Exclusion of UTI  Presence of symptoms >3 months  Characteristic view at cystoscopy (in 70%)  Exclusion of all other bladder illnesses

 Pelvic pain and dyscomfort  Frequent urination  Urge symptoms  Negative urine test  Exclusion of UTI  Presence of symptoms >3 months  Characteristic view at cystoscopy (in 70%)  Exclusion of all other bladder illnesses

Extension of visible mucosa glomerulations depends on: level of intravesical pressure time of dilation. Standardization and optimization of these parameters is urgently needed. Extension of visible mucosa glomerulations depends on: level of intravesical pressure time of dilation. Standardization and optimization of these parameters is urgently needed.

Issues at conventional hydrodilation Unreliable volume control Vesico-ureteral (renal) reflux Leakage through the urethra Uncertainties at pressure adjustment Inaccurately defined zero level Reference pressure must correspond with perivesical pressure Adjustment of hydrostatic pressure is unexact NEW METHOD NEEDED

Hyaluronate + 2% Lidocain solution into the bladder Balloon filled up to 70cmH 2 O Keep pressure for 5 minutes Quick collapse: ex vacuo bleedings Hyaluronate + 2% Lidocain solution into the bladder Balloon filled up to 70cmH 2 O Keep pressure for 5 minutes Quick collapse: ex vacuo bleedings Standardized circumstances

After balloon dilation Unequivocal lesions visible Extended, deep coagulation (vaporization) of all mucosal glomerulations and ulcers Bladder catheter for hours Adjuvant Hyaluronate + Lidocain instillations Repeated instillations weekly 2x for 2 weeks, weekly 1x for 4 weeks (8 times) Continuous follow up by questionaires and miction diary

Evaluation of pressure-volume relation: Always a bi-parabolic correlation! Bladder wall rupture ! Suddenly decreasing pressure Suddenly decreasing pressure

Evaluation of pressure-volume relation: cysto-elastometric PC software

Use balloon dilation of the bladder instead of conventional hydrodilation Proved advantages: - no leakage - no v-u reflux - exact and reliable pressure controll - better visualisation of all mucosal lesion - simultaneous high pressure drug delivery Standardized parameters (pressure, time) Summary of our experiences

Extended and deep coagulation of all mucosal lesions Adjuvant GAG replenishment therapy helps (best timing, dose and durance ?) Repeated procedure - if necessary - brings similar result Evaluation of volume-pressure dependence let define new objective parameters: bladder volume, distensibility, grade of dilation

Presented method is of Diagnostic value Better visualisation of all mucosal lesions Therapeutic value Extended coagulation of otherwise unvisible lesions Prognostic value Evaluation of pressure-volume relation let rate phase of the illness