Do symptoms correlate with cystoscopic findings in newly diagnosed PBS/IC?

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May 2 2006

In patients with untreated and newly diagnosed PBS/IC, can one find a correlation between symptoms and cystoscopic findings?

In the Interstitial Cystitis Database Study (ICDB) which looked at a combination of previously diagnosed and treated and new patients, not much of a relationship was noted. Pain was not significantly related to any cystoscopic findings, except for a weak association with Hunner's patch, whose presence was related to increased urethral tenderness. No correlation between pain and maximal cystometric capacity was noted.

Lamale and the group at the University of Iowa restudied at this question in 12 newly diagnosed and untreated PBS/IC patients undergoing cystoscopy under anesthesia with bladder distention and biopsy. They found that pain symptoms had consistent positive correlations with cystoscopic findings. An increase in pain with bladder filling was associated with inflammation, ulceration, and smaller bladder capacity. Pain relief after voiding correlated with smaller bladder capacity, hematuria, and severity of changes on cystoscopy. Like the ICDB study, pain intensity in the urethra was related to ulceration and hematuria. Pain in the lower abdomen was also a marker for lower bladder capacity and more severe bladder changes on endoscopy. Interestingly, daytime frequency had a negative correlation with cystoscopic severity while nocturia was positively associated with severe interstitial cystitis changes and smaller bladder capacity.

Based on this work, one can surmise that urethral tenderness and nocturia and significant pain in untreated patients portend increased likelihood of an abnormal endoscopic picture with bladder distention. Daytime frequency and urgency do not.

By Philip Hanno, MD, MPH

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