According to ESSIC, Hunner's ulcer is not an ulcer but rather a
distinctive inflammatory lesion presenting a characteristic
deep rupture through the mucosa and
submucosa provoked by bladder distention. The
word ‘‘ulcer’’ suggests that it can be seen at
cystoscopy without hydrodistention. Consequently,
ESSIC replaced the name Hunner’s ulcer by Hunner’s
lesion. The following definition by Fall was
accepted. ‘‘The Hunner’s lesion typically presents
as a circumscript, reddened mucosal area with small
vessels radiating towards a central scar, with a fibrin
deposit or coagulum attached to this area. This site
ruptures with increasing bladder distension, with
petechial oozing of blood from the lesion and the
mucosal margins in a waterfall manner. A rather
typical, slightly bullous edema develops post-distension
with varying peripheral extension."
The role of cystoscopy in the diagnosis of Hunner's ulcer disease. Braunstein R, Shapiro E, Kaye J, Moldwin R. J Urol 2008;180:1383-6
- this study shows that standard clinical evaluation cannot reliably distinguish IC patients with and without a Hunner's lesion - the authors conclude that cystoscopy is needed to accurately identify patients with Hunner's ulcer - in this study, the diagnosis of IC was strictly made according to the NIDDK criteria implying that cystoscopy with hydrodistension was done
Efficacy of prednisone for severe refractory ulcerative interstitial cystitis. Soucy F, Gregoire M. J Urol 2005;173:841-3; discussion 843PMID: 15711286
Intravesical nitric oxide production discriminates between classic and nonulcer interstitial cystitis. Logadottir YR, Ehren I, Fall M, et al. J Urol 2004;171:1148-50 - luminal nitric oxide was measured in the bladder of patients using a chemiluminescence nitric oxide (NO) analyzer
- all patients with classic IC (=with Hunner's lesion, BPS types 3A, 3B and 3C) had high levels of NO
- none of the other patients had any significant increase in NO levels in the bladder
- the NO level in patients with classic IC was not related to symptoms but rather to the assignment to this specific subgroup of IC
- the highest levels of NO were found in patients in the initial phase of classic IC
Primary evaluation of patients suspected of having interstitial cystitis (IC). Nordling J et al. Eur Urol 2004;45:662-9 PMID: 15082211
Toward a precise definition of interstitial cystitis: further evidence of differences in classic and nonulcer disease. Peeker R, Fall M. J Urol 2002;167:2470-2 PMID: 11992059
Interstitial cystitis: report of cases. Peterson A, Hager BH. Cal West Med 1929;31:262-7.
• the authors say: Many continue to refer to it as an ulcer, but it is not an ulcer
in the true sense of the conception. The term is poor because it conveys something which it is not.
Elusive ulcer of the bladder: further notes on a rare type of bladder ulcer with report of 25 cases. Hunner G. Am J Obstet 1918;78:374-95
A rare type of bladder ulcer in women: report of cases. Hunner GL. Boston Med Surg J 1915;172:660-4
