Highlights
- •Histopathological analysis from random biopsies could distinguish bladder carcinoma from clinically suspected IC/BPS.
- •Hydrodistension is more likely to be effective when chronic pelvic pain is obviously alleviated.
- •The efficacy of hydrodistension could act in a certain period of time.
Abstract
Objective
We aimed to explore the diagnostic and therapeutic efficacy of cystoscopy with hydrodistension
and random biopsies for clinically suspected interstitial cystitis/bladder pain syndrome
(IC/BPS).
Study design
We reviewed the data of fifty-five clinically suspected IC/BPS patients underwent
cystoscopy with hydrodistension and random biopsies. Global Response Assessment was
used to evaluate the efficacy. Disease severity was assessed by thorough history,
physical examination, 3-day frequency volume chart, visual analog scale of pain, Interstitial
Cystitis Symptom Index (ICSI) and clinical phenotype system (UPOINT).
Results
According to the pathologic outcomes from random biopsies, three out of the 55 clinically
suspected IC/BPS were diagnosed as bladder carcinoma. Among the 52 IC/BPS patients,
thirty-six patients (69.2%) had initial chief complaints of urinary frequency and
urgency. Under cystoscopy, twenty-nine patients and 23 patients were classified as
Hunner ulcer type and diffuse global mucosal bleeding (grade III glomerulation). The
median functional bladder capacity of the 52 IC/BPS patients was 100 ml. Hydrodistension
was effective in 28 patients (53.8%) at postoperative 3 months, which decreased to
25% at post-hydrodistension 6 months and to 13.5% at 12 months. For the 28 hydrodistension-effective
patients, the remission degrees of daytime frequency, nocturia, VAS bladder pain and
ICSI score were 50.3%, 49.4%, 68.1% and 48%, which were significantly higher than
the 16.9% (daytime frequency, P < 0.001), 20.5% (nocturia, P = 0.021), 7.4% (VAS pain
score, P < 0.001) and 6.1% (ICSI, P < 0.001) in the hydrodistension-negative group.
According to the UPOINT system, the hydrodistension-effective cases had significantly
higher rates of symptom remission in U (P = 0.002), P (P = 0.026), O (P < 0.001),
and T (P < 0.001) domains than the corresponding negative cases. In effective group,
the O domain had the most remission rate (26 out of 28, 92.9%, P < 0.001), followed
by the U domain (12 out of 28, 42.9%, P < 0.001) and T domain (12 out of 28, 42.9%,
P < 0.001).
Conclusion
Histopathological analysis from random biopsies could distinguish bladder carcinoma
from clinically suspected IC/BPS. Hydrodistension is more likely to be effective when
chronic pelvic pain is obviously alleviated. The efficacy of hydrodistension could
act in a certain period of time.
Keywords
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Article info
Publication history
Published online: August 26, 2021
Accepted:
August 24,
2021
Received in revised form:
August 15,
2021
Received:
March 12,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
