Hunner-type interstitial cystitis (IC) is a chronic inflammatory bladder condition typically associated with female patients. Male cases remain underdiagnosed due to symptom overlap with chronic prostatitis or chronic pelvic pain syndrome. We hypothesised that targeted endoscopic and histologic evaluation in male patients with longstanding lower urinary tract symptoms (LUTS) and pelvic pain would reveal overlooked cases of Hunner-type IC. The aim of this study was to characterise the clinical presentation, diagnostic pathway and treatment outcomes of male patients with newly diagnosed Hunner-type IC.

We performed a single-centre retrospective observational study conducted between September 2024 and March 2025. Six male patients (mean age: 59.5 ± 10.2 years) with a newly diagnosed Hunner-type IC were included. Diagnosis was based on ICS-defined clinical criteria, cystoscopic visualisation of Hunner lesions, and histological confirmation. Inclusion criteria: male gender, age ≥18 years, chronic pelvic pain and/or LUTS for ≥6 months, and confirmed Hunner lesions via cystoscopy and biopsy. Exclusion criteria: known bladder malignancy, active urinary tuberculosis, or previously established IC diagnosis. All patients underwent comprehensive urological assessment including laboratory testing, urine culture, pelvic ultrasound, and cystoscopy under anaesthesia. Surgical treatment included hydrodistention and bipolar electrocoagulation of Hunner lesions. Histology included routine staining and mast cell immunohistochemistry. Pain was assessed using the Visual Analogue Scale (VAS). Bladder instillations (hyaluronic acid, sodium alginate, antiseptics), transcutaneous electroneurostimulation (presacral and tibial), and pharmacological management (pentosan polysulfate, solifenacin, mirabegron, clomipramine, gabapentin) were provided postoperatively. Follow-up duration was 5 months.

All patients presented with suprapubic or perineal pain (100%), urinary urgency/frequency (up to 40/day in 100%), nocturia (up to 10/night in 83.3%), and sensation of incomplete bladder emptying (83.3%). Mean duration of symptoms prior to diagnosis was 5.8 ± 3.0 years. All patients had previously consulted urologists, but IC was not diagnosed. Cystoscopy confirmed Hunner lesions in all 6 patients (100%). One patient had prior cystoscopy without identification of lesions. Histological findings included chronic inflammation with lymphoplasmacytic infiltration, urothelial erosions, and increased mast cell density in all cases. Mean VAS pain score decreased from 8.0 preoperatively to 3.0 postoperatively (p<0.05). Two patients (33.3%) achieved symptom reduction >80% by self-assessment; others reported moderate improvement (40–60%). Duration of symptom remission ranged from 2 to 5 months. Urine cultures were positive in 4 patients (66.7%), identifying Morganella morganii, E. coli, Klebsiella oxytoca, Staphylococcus spp., and Enterococcus faecalis. Comorbidities included chronic hepatitis C (3/6) and HIV infection (1/6).

Despite its rarity in men, Hunner-type IC should be considered in patients with chronic pelvic pain and LUTS, particularly when standard treatment for chronic prostatitis fails. Endoscopic and histologic assessment is essential for diagnosis. The observed symptom burden and diagnostic delay highlight a lack of awareness regarding IC in the male population. Positive treatment outcomes with a multimodal approach underscore the potential benefits of early, targeted intervention.

Hunner-type IC in men is a clinically significant yet underrecognised condition. A combination of cystoscopic evaluation, histological confirmation, and comprehensive therapy can result in meaningful symptom relief. Greater awareness and inclusion of IC in differential diagnoses of chronic pelvic pain in men are needed to reduce diagnostic delays and improve patient outcomes.