Glomerulation refers to bladder hemorrhages which are thought to be associated with some types of interstitial cystitis (IC). The presence of glomerulations, also known as petechial hemorrhages, in the bladder suggests that the bladder wall has been damaged, irritated, and/or inflamed. Petechial hemorrhages originate from punctuate hemorrhages. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diagnostic Criteria for IC, developed in 1987, required the presence of glomerulations or Hunner's Ulcers for diagnosis of IC and is still used today, to determine eligibility for some clinical trials. However other research has theorized that the hydrodistention procedure used for the diagnosis of IC itself may have created these tiny broken blood vessels. Studies have found glomerulations in asymptomatic populations, suggesting that they are not applicable as a marker for IC. Thus, a diagnosis of IC is now based upon other, less invasive methods, such as the PUF Scale (Pelvic Pain and Urgency/Frequency Patient Symptom Scale). Glomerulation has been observed to be one of the feature for prostate cancer. However, efforts to determine whether this is association or causation have concluded that while glomerulations may be a common finding in individuals with prostate cancer, they are not a significant predictor. Presentation Glomerulations appear as checkerboard/lattice patterns, splotches, or pinpoint-sized red marks on the bladder. Glomerulations are classified into five grades that take into consideration the type and location of injury: Grade 0 (normal mucosa), Grade I (petechiae in at least two quadrants), Grade II (large submucosal bleeding), Grade III (diffuse global submucosal bleeding), and Grade IV (mucosal disruption, with or without bleeding). According to NIDDK criteria for inclusion in IC studies, examination for glomerulations is performed following hydrodistention of the bladder. In this procedure, water is instilled into the bladder to a pressure of 80–100 cm for 1–2 minutes. When water is drained from the bladder, glomerulations may appear. To be considered as IC, these submucosal hemorrhages must be present in at least 3 quadrants of the bladder with over 10 glomerulations per quadrant. Glomerulations should not be along the path of cystoscope which may suggest trauma instead. Pathophysiology The pathophysiologic mechanism of glomerulations is unknown and debated. Some researchers suggest it may be the bladder's response to prolonged periods of underfilling. Another possible mechanism of glomerulation is over expression of angiogenic growth factors in the bladder. It has been shown that glomerulations are also presented under hydrodistension procedures. During