Nitric oxide:: A useful gas in the detection of lower urinary tract inflammation

Purpose: Luminal nitric oxide has been shown to be elevated in the bladder of patients with cystitis of various etiologies. We determine whether luminal nitric oxide can be used as a marker to differentiate inflammation, that is interstitial cystitis, from urgency, frequency, nocturia and pain due to noninflammatory disorders, such as outflow obstruction and neurogenic dysfunction. Materials and Methods: We measured luminal nitric oxide in the bladder of patients with urgency due to detrusor instability (6), outflow obstruction (7), sensory urge (19) and interstitial cystitis (8), and controls without urgency symptoms (11). Nitric oxide-free air was incubated in the bladder for 5 minutes and analyzed in a chemiluminescence nitric oxide analyzer. Results: There was a nearly 20-fold increase in mean bladder nitric oxide concentration in patients with interstitial cystitis (234 +/- 67 parts per billion) compared to those with detrusor instability (11 +/- 1), outflow obstruction (9 +/- 1) and sensory urgency (10 +/- 1), and controls (13 +/- 2). Conclusions: Measurement of nitric oxide in air from the bladder is a simple, safe and fast method to differentiate urgency due to inflammation from neurogenic disorders or outflow obstruction. The simplicity of this method makes it potentially useful as a screening method for office use.