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Correlation of symptoms in women with bladder pain syndrome/interstitial cystitis (BPS/IC) with cystoscopy & histologic findings
IUGA Academy. Arunkalaivanan A. Jun 30, 2018; 212863; 278 Topic: Pelvic Pain
Dr. Angamuthu Arunkalaivanan
Dr. Angamuthu Arunkalaivanan

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278

Correlation of symptoms in women with bladder pain syndrome/interstitial cystitis (BPS/IC) with cystoscopy & histologic findings

Arunkalaivanan, A1; Kaur, H2; Gaman, A3

1: Waikiki Specialist Centre; 2: Waikiki Private Hospital; 3: Clinipath Pathology

Introduction: Bladder Pain Syndrome/Interstitial Cystitis(BPS/IC) is defined as an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes(1). The diagnosis is usually made by evaluation of symptoms, cystoscopic and histologic findings. Because of the heterogenous nature of the disease, the presentations may vary considerably.

Pudendal neuropathy is a common feature of syndromes such

as dysfunctional voiding, non-obstructive urinary retention,

chronic pelvic pain syndromes, and urinary and faecal inconti-

nence.

Objective:?Correlate cystoscopic and histologic findings of the women with BPS/IC.

Methods: We performed a chart review of 47 women with the newly diagnosed BPS/IC cases in the year of 2017. The patients’ bladder symptoms at the first visit, cystoscopic findings and biopsy reports were recorded.

Table 1. Cystoscopic findings were converted to a numerical scale:

Points

0

1

2

3

4

Capacity (ml)

800+

600-799

400-599

200-399

0-199

Terminal haematuria

Absent

Present

Mucosal lesions

Absent

Mild

Moderate

severe

Table 2. Scaled cystoscopic score

Original Total score

Scaled score

0

0, No e/o BPS/IC

1-3

1, Mild BPS/IC

4-6

2, Moderate BPS/IC

7-9

3, Severe BPS/IC

Based upon the mast cell count, histological severity is Grade 1 (28-100/mm2), Grade 2 (101-200/mm2), Grade 3 (>200/mm2). Symptoms were compared with the cystoscopic and histological findings using Pearson’s correlations. The data were analysed using IBM-SPSS v24.

Results: Age-35.1±11.3; Parity 0-3 (Median 1); Duration of symptoms-24.5±15.2months; Pelvic pain-45(95.7%); Dyspareunia-42(93.3%); Pain on filling-38(80.9%); Urethral pain-30(63.8%); Urgency-47(100%). Mean bladder capacity under hydrodistension was 625.9±196.1, (range150 to 1000ml), Mast cell count was 137.6±43.2, (range 72-250).

Table 3. Percentage of patients with BPS/IC

Finding

%

Daytime frequency

5-10 voids

59.6%

11-15 voids

36.2%

>16 voids

4.3%

Nocturia

<5 voids

93.6%

>5 voids

6.4%

Cystoscopic severity score

Mild

4.5%

Moderate

89.4%

Severe

6.4%

Mast cell count

Grade 1

17%

Grade 2

70.2%

Grade 3

12.8%

Table 4. Pearson’s correlations

Symptom

Bladder capacity

Cystoscopic score

Mast cell grading

Frequency

0.03

0.17

0.02

Nocturia

0.26

-0.03

0.04

Duration

0.13

0.02

-0.09

Pain on filling

0.1

-0.36*

0.13

Urethral pain

0.07

-0.05

0.3*

Pelvic pain

-0.14

-0.01

-0.01

Dyspareunia

-0.29

-0.01

0.02

*p <0.05

Pain on filling was correlated negatively with the cystoscopic score (p=0.012); Urethral pain was positively correlated with the higher mast cell grading (p=0.03) whereas the other symptoms do not correlate with either the cystoscopy or mast cell count on histology.

Conclusions:? Our study indicates that the untreated patients have a strong correlation between urethral pain and mast cell severity, interestingly pain on filling was negatively correlated with cystoscopic scoring. However, none of the other symptoms have any positive correlation with the cystoscopy and histological features compared to the other studies(2, 3). Therefore, additional multi-centric longitudinal studies are required to examine the role of these diagnostic tools in further management of this debilitating condition of BPS/IC.

References:

  1. J Urol. 2011;185(6):2162-70.
  2. Urology. 2006;67(2):242-5.
  3. Scand J Urol Nephrol. 2009;43(6):471-5.

Disclosure:

Work supported by industry: no.

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