Antecedent Nonbladder Syndromes In Case-Control Study Of Interstitial Cystitis/Painful Bladder Syndrome

Main Category: Urology / Nephrology
Article Date: 27 Dec 2008 - 0:00 PDT

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UroToday.com - Nonbladder Syndromes Often Precede Onset of BPS

In this important article, Dr. John Warren and colleagues from Baltimore, Rochester, New York, and Ann Arbor prove their hypothesis that certain syndromes precede BPS and thus might provide clues to its pathogenesis. They studied 313 cases of BPS and matched them to 313 controls by sex, age, region, and index date-interview interval. Only 1 syndrome was diagnosed in significantly fewer cases than in controls: diabetes treated with oral medications. This interesting finding has been alluded to in the past, and merits further investigation.

No significant differences were found between cases and controls in 12 diseases diagnosed by physicians: hypothyroidism, mitral valve prolapse, shingles, cancer, inflammatory bowel disease, insulin-treated diabetes, hyperthyroidism, Lyme disease, multiple chemical hypersensitivity, or systemic lupus erythematosis. Antecedent syndromes significantly more prevalent in the cases by physician diagnosis were: fibromyalgia, irritable bowel syndrome, migraine, panic disorder, endometriosis, asthma, and depression. Allergy was more common by self-report. Vulvadynia and sicca syndrome symptoms were more common in the BPS population as well.

Warren notes that vulvodynia, no matter how it was defined, had an antecedent prevalence of 2-8%, far less that its 12-61% reported association with BPS. He suggests that the data implies that vulvodynia is an infrequent antecedent predictor of BPS, but is a common referred pain from the condition. Fibromyalgia-chronic widespread pain, chronic fatigue syndrome, sicca syndrome, and irritable bowel syndrome were associated with each other by pairwise and factor analyses using numerous assumptions. The conclusion of the article is hard to escape. In some patients, BPS is a local manifestation of a systemic syndrome.

Warren JW, Howard FM, Cross RK, Good JL, Weissman MM, Wesselmann U, Langenberg P, Greenberg P, Clauw DJ.
Urology, article in press doi:10.1016/j.urology.2008.06.031
Written by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

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