Dilemmas In Diagnosing Pelvic Pain: Multiple Pelvic Surgeries Common In Women With Interstitial Cystitis

Main Category: Urology / Nephrology
Also Included In: Clinical Trials / Drug Trials
Article Date: 30 May 2008 - 0:00 PDT

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UroToday.com - Most women with BPS/IC have chronic pain, often lasting for several years. Patients with urinary urgency, frequency, and pain often seek multiple specialists to help diagnose and treat their symptoms. Ingber and colleagues from Royal Oak, Michigan report on the first American population-based study to look at the prevalence of pelvic surgeries in an established IC population, and the community. Women with BPS/IC who met National Institute of Health (NIDDK) criteria were compared with a control group of women in the community and matched by age and place of residence, with a ratio of 1 case to 12 controls.

In this mail survey, 53% of BPS/IC and 16% of controls responded. This amounted to 215 BPS/IC patients who were compared to 823 controls. Highlights of the data show that 42.3% of BPS/IC had hysterectomies compared to 21.4% of controls. Bladder suspensions were 4 times more common in the BPS/IC patients than controls, and laparoscopic pelvic surgical procedures almost 3 times as common. Endometriosis was diagnosed in 9.8% of controls and in 25.6% of BPS/IC patients. Focusing on hysterectomies, the authors found that 68% were done before a diagnosis of BPS/IC had been made. The finding that the majority of women with BPS/IC with a history of hysterectomy or bladder suspension had these surgical procedures before or the same year as their diagnosis of BPS/IC was made could indicate some sort of trigger for the development of symptoms of BPS/IC. Further data on the actual onset of the BPS/IC symptoms could give this hypothesis some grounding or dispel it altogether.

Often there was a 1-5 year delay after hysterectomy until BPS/IC was diagnosed. While the study cannot show that the surgical procedures were unnecessary, the clear implication of this important article is that we still have a problem in recognizing BPS/IC and this may be resulting not only in prolonged pain and suffering for the patients, but also unnecessary surgical procedures for pelvic pain.

Reported by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

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