Thirty years ago Sant recognized that glomerulations were not pathognomonic for BPS. And it was recognized that glomerulations were present in many other conditions such as radiation cystitis and carcinoma in situ. This is still true today. And studies published in recent years showed that glomerulations also appear in a range of other conditions, such as upper urinary tract stones, BPH/LUTS and prostatitis, as well as in asymptomatic populations [1–6].

Sant also argues that cystoscopic findings frequently do not correlate with symptoms or response to treatment. This stance has not been challenged in the last 30 years when considering glomerulations. Recent studies have not shown any link between severity of symptoms and the grade of glomerulations [7–10].

Cystoscopy should still be a prerequisite for establishing the diagnosis of BPS, as the diagnosis of carcinoma in situ, and other confusable diseases as recommended by the ESSIC consensus should be ruled out before making the diagnosis.

Glomerulations, although present in many patients with BPS, is not considered a hallmark of BPS syndrome anymore [11]. Countless studies have demonstrated the presence of glomerulations in patients without symptoms of BPS, and they cannot be linked to severity of symptoms or bladder capacity under anesthesia. Also some studies suggest that up to 35% of a population with BPS did not have glomerulations [12, 13]. These studies indicate that the occurrence of glomerulations no longer have any value in clinical diagnostics of BPS [11].

Waxman et al. 1998 published the first double blinded study where the occurrence of glomerulations was studied in an asymptomatic population [1]. This study found the prevalence to be as high in the symptomatic group as in the asymptomatic. Although this study was published in 1998, there has been no repeat blinded study looking for glomerulations in asymptomatic populations, but in later years several studies have been published that show glomerulations in patients with other urological conditions, such as BPH/LUTS. Another important study was conducted by Wyndaele et al., who found that 24% of patients with severe BPS symptoms had no glomerulations [10]. Also Simon et al., and Richter et al. showed that the occurrence of glomerulations in patients with BPS vary greatly [12, 13].