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literature on Hunner's lesion (Hunner's "ulcer")

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."

See also: Diagnostic Criteria, Classification, and Nomenclature for Painful Bladder Syndrome/Interstitial Cystitis: An ESSIC Proposal. Eur Urol 2008;53:60-7

  • 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 843 PMID: 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
    - t
    he NO level in patients with classic IC was not related to symptoms but rather to the assignment to this specific subgroup of IC
    - t
    he 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
  • In memoriam; Guy Le Roy Hunner; 1869-1957
    Kuder R. Md State Med J 1958;7:77-8
  • Hunner's ulcer
    Kinder CH, Smith RD. Br J Urol 1958;30:338-43 [PMID: 13584775]
  • 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



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