Endometriosis/adenomyosis is associated with more typical cystoscopic findings of interstitial cystitis in patients with elevated PUF scores

Abstract

In this paper, we present our experience with cystoscopy and hydrodistension for the diagnosis of interstitial cystitis (IC) and association with endometriosis/adenomyosis. This is a retrospective study of 116 patients who have undergone cystoscopy and hydrodistension because of suspicion of interstitial cystitis as shown by elevated Pain Urgency and Frequency questionnaire (PUF) scores and, in some patients, positive potassium sensitivity test (PST) or anesthetic bladder challenge (ABC) tests as well. Cystoscopic findings were grouped into “no IC,” “atypical IC,” and “typical IC” groups. Chi-square analysis was used for comparing percentages. PUF questionnaire showed high sensitivity (98%) with ≥5 score but low specificity (0%). The best specificity was found with PST (30%). Among IC patients, 60 (60%) had adenomyosis or endometriosis with an increasing endometriosis/adenomyosis rate from “no IC” to “typical IC” groups (37.5% to 67.74%, P < 0.05). PST is the most specific of the screening tests for IC, and cystoscopy with hydrodistension is the only test that allows direct visualization and grading of bladder abnormalities as “typical”, “atypical”, and “no IC”. The presence of endometriosis has a stronger association with typical IC findings on cystoscopy including glomerulations, ulcers, and reduced bladder capacity.