Abstract
ObjectivesTo revisit the diagnostic roles of cystoscopic hydrodistention and the potassium sensitivity test (PST) for the diagnosis of interstitial cystitis (IC).MethodsWe prospectively enrolled 214 patients clinically diagnosed with IC, 125 non-IC patients who underwent video urodynamic studies and PST, and another 144 non-IC patients who underwent cystoscopic hydrodistention before transurethral surgery. The sensitivity, specificity, and positive and negative predictive values were calculated for the PST and glomerulations after cystoscopic hydrodistention.ResultsAfter cystoscopic hydrodistention, glomerulations developed in 211/214 (98.6%) IC patients and 61/144 (42.4%) of the non-IC patients including patients with stones (45/67, 67%), hematuria (2/5, 40%), and stress urinary incontinence (SUI) (6/17, 35%). When positive glomerulation was defined as grade 2 or more, the sensitivity was 61.7%. The PST was positive in 183/214 (85.5%) IC patients and 7/17 (41%) with hypersensitive bladder, 7/32 (22%) with detrusor overactivity, 5/27 (18%) with SUI, 2/21 (10%) with lower urinary tract symptoms, and 2/25 (8%) with bladder outlet obstruction. The PST had a sensitivity of 85.5% and a specificity of 81.6% for diagnosis of IC. IC patients with a positive PST had a significantly smaller urgency sensation capacity, smaller voided volume, and greater bladder pain score.ConclusionsBoth the PST and glomerulations after hydrodistention are sensitive indicators of IC, but the specificity of glomerulations in the diagnosis of IC is lower than that of the PST. A positive PST is associated with a more hypersensitive bladder and bladder pain, but not the grade of glomerulations in IC patients. Neither test provided 100% diagnostic accuracy for IC, we might select patients into different subgroups based on different PST and hydrodistention results, not for making a diagnosis of IC but for guidance of different treatments.
Highlights
Interstitial cystitis (IC) is characterized by bladder pain associated with urgency, frequency, nocturia, and sterile urine [1]
Glomerulations developed in 211/214 (98.6%) IC patients and 61/144 (42.4%) of the non-IC patients including patients with stones (45/67, 67%), hematuria (2/5, 40%), and stress urinary incontinence (SUI) (6/17, 35%)
The potassium sensitivity test (PST) was positive in 183/214 (85.5%) IC patients and 7/17 (41%) with hypersensitive bladder, 7/32 (22%) with detrusor overactivity, 5/27 (18%) with SUI, 2/21 (10%) with lower urinary tract symptoms, and 2/25 (8%) with bladder outlet obstruction
Summary
Interstitial cystitis (IC) is characterized by bladder pain associated with urgency, frequency, nocturia, and sterile urine [1]. The diagnosis of IC is based on the symptomatology and urological findings including characteristic cystoscopic features after hydrodistention under anesthesia [2]. The disease has been known for more than a century, the pathophysiology of IC remains unclear, and its diagnosis is based on the exclusion of other diseases [3]. IC is classified into ulcerative IC and non-ulcerative IC based on the cystoscopic findings of the presence of Hunner’s lesions and glomerulations that develop after hydrodistention [4,5]. Since IC is a diagnosis of exclusion, it is rational to exclude any possible etiology for the presenting symptoms of bladder pain, frequency, and urgency
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