Prognostic Factors For Bladder Pain Syndrome / Interstitial Cystitis Suggested By Danish Study

Main Category: Urology / Nephrology
Also Included In: Pain / Anesthetics
Article Date: 30 Nov 2009 - 7:00 PDT

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UroToday.com - A study designed to assess the criteria for BPS proposed by the European Society for the Study of Interstitial Cystitis (ESSIC) characterized and evaluated a large Danish patient population with BPS with a follow-up extending back to 1966. The assumption, in the study reported by Richter and colleagues from Copenhagen was that patients with mild as well as more severe BPS would be included in the study, in contrast to inclusion according to strict NIDDK criteria. The authors estimated whether clinical variables previously or at present regarded as diagnostic criteria had any value for predicting the course of the disease. While it suffers from being a retrospective study, the findings are nevertheless very compelling. Criteria for entry into the database were pain, pressure or discomfort perceived by the patient to be related to the bladder. All patients were evaluated by cystoscopy under anesthesia with hydrodistention and biopsy. In all, 386 patients were identified with a median age at diagnosis of 53 years, comprising 360 females and 26 males. Complete data sets for evaluation were available in 349 patients.

Nocturia had a statistically significant association with treatment intensity (a surrogate for prognosis in the study). At cystoscopy, 42% of all patients had a reduced bladder capacity of less than 500cc under anesthesia. Capacity was not associated with treatment intensity. Glomerulations, present in two-thirds of patients were likewise not associated with prognosis. Fifty-three percent of patients had detrusor mastocytosis on deep biopsy, and both detrusor mastocytosis and the presence of intrafasicular fibrosis foreshadowed the need for more numerous and aggressive treatment approaches.

Statistical analysis ruled out one possible obvious cause of bias in this research, as symptom severity was a more important determinant of the choice of treatment than clinical findings. It appears the ESSIC criteria can be used not only prospectively, but also retrospectively to allow for epidemiologic and clinical research comparisons of groups of patients with BPS.

Richter B, Hesse U, Hansen AB, Horn T, Mortensen SO, Nordling J
BJU Int. 2009 Sep 14. Epub ahead of print.
doi:10.1111/j.1464-410X.2009.08847.x
Written by UroToday.com
Contributing Editor Philip M. Hanno, MD, MPH

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