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EDITORIAL COMMENTS

The authors designed a laboratory study to confirm objectivelywhat many patients with interstitial cystitis and clinicians have longsuspected, that is stress increases interstitial cystitis symptoms.Patients and controls were exposed to standard laboratory stresssituations, and then pain and urgency scores were measured as wellas physiological and psychological stress responses. The interstitialcystitis and control groups had similar physiological and psycholog-ical stress responses. However, the 2 groups had different bladderresponses to stress. Controls had no change in pain or urgency withstress but patients with interstitial cystitis had increased pain andurgency during and after stress.

The study makes an important contribution by demonstratingobjectively that psychological stress increases interstitial cystitissymptoms. Also, this noninvasive laboratory test would be useful infuture studies to define the mechanisms by which stress increasesinterstitial cystitis symptoms. The authors suggest several possiblemechanisms. For example, stress involves the secretion of cortico-tropin releasing hormone, which is a potent activator of mast celldegranulation. Sympathetic nervous system activity may also inducemast cell degranulation. Stress also involves the release of norepi-nephrine, which may potentiate inflammation pain by inducing pros-taglandin release. These mechanisms may be tested by measuringurine and serum mediators. For example, to evaluate the role of mastcell degranulation one would measure urinary histamine andtryptase in patients and controls at baseline, during and after thelaboratory stress test. After defining the mechanisms new interven-tions may be developed to block the stress induced exacerbation ofinterstitial cystitis symptoms.

Deborah EricksonDepartment of UrologyMilton S. Hershey Medical CenterHershey, Pennsylvania

The authors confirm by a laboratory study what we all know fromour medical practices, that is stress tends to intensify the symptom-atic expression of most diseases. Nowhere does this truism applymore than to interstitial cystitis. Their argument would have beenstrengthened if there had been an interstitial cystitis group with anonstressful task to perform to serve as active controls. My impres-sion is that many healthy individuals have urinary frequency whenin a stressful situation. A study similar to that of the authors may bemodified to demonstrate the role that stress and sympathetic activityhave in voiding behavior in the normal and diseased states. Since inmany ways interstitial cystitis is an exaggeration of the symptomsuniversally experienced by persons with a full bladder, such infor-mation would prove useful.

Philip M. Hanno657 Augusta Ct.Berwyn, Pennsylvania

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