Abstract
To evaluate the correlations of clinical symptoms, urodynamic parameters, and long-term treatment outcomes with different findings of cystoscopic hydrodistention (HD) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). This retrospective analysis of 486 patients with IC/BPS investigated baseline clinical symptoms, disease duration, medical comorbidities, urodynamic findings, cystoscopic characteristics [including maximal bladder capacity (MBC) and the presence of glomerulations and Hunner’s lesions], and outcomes according to the five IC/BPS HD subtypes based on the glomerulation grade, MBC, and the presence of Hunner’s lesions. Receiver operation characteristic analysis identified an optimal cutoff value of MBC ≥ 760 ml as a predictor of satisfactory outcomes. Glomerulation grade and MBC were significantly correlated (r = − 0.403, P < 0.001), and both were significantly associated with IC Symptom Index scores. The rate of satisfactory outcomes was better for the patients with low glomerulation grade and MBC ≥ 760 ml (64.2%), and significantly worse for those with Hunner’s lesions (36.8%); no significant differences were noted among the other groups. The results suggested that IC/BPS patients can be classified into the following three distinct subgroups: (1) those with low glomerulation grade and MBC ≥ 760 ml; (2) those with low glomerulation grade and MBC < 760 ml, or with high glomerulation grade regardless of MBC; and (3) those with Hunner’s lesions. The results showed that three IC/BPS subgroups had distinct bladder characteristics and treatment outcomes. The patients with high MBC and low glomerulation grade after HD had more medical comorbidities but a significantly higher rate of satisfactory treatment outcome.IRB: 105-25-B.
Highlights
To evaluate the correlations of clinical symptoms, urodynamic parameters, and long-term treatment outcomes with different findings of cystoscopic hydrodistention (HD) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS)
Careful examination of cystoscopic findings after HD usually found that there was no strict association between the maximal bladder capacity (MBC) and glomerulations grade. These findings suggest that Interstitial cystitis (IC)/BPS bladders should be classified into more detailed subtypes than just the presence or absence of Hunner’s lesions, and a possible classification based on cystoscopic findings should be examined to establish whether it can reflect clinical characteristics and treatment outcomes
The receiver operation characteristic analysis showed that the optimal cutoff value for MBC for predicting a satisfactory outcome of global response assessment (GRA) ≥ 2 was ≥ 760 ml
Summary
To evaluate the correlations of clinical symptoms, urodynamic parameters, and long-term treatment outcomes with different findings of cystoscopic hydrodistention (HD) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). The characteristic glomerulations during cystoscopic HD were not observed in several patients suffering from bladder pain, urinary frequency, and nocturia; “bladder pain syndrome” was suggested as a name for this subset of s ymptoms[3], and the recent Asian IC guidelines describe. It as “hypersensitive bladder syndrome”[4]. There is a need to reconsider the classification of IC/BPS based on other clinical characteristics
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