BERKELEY, CA (UroToday.com) - In a large, retrospective study of 185 patients with PBS/IC subjected to hydrodistention under general anesthesia for five minutes and then repeated after emptying for another 5 minutes, 6 month symptomatic improvement was identified in only 5%. Cole, Scarpero, and Dmochowski attempted to identify symptom characteristics that would suggest using distention therapeutically. Patients were divided into 1) a group reporting pain with bladder filling relieved with emptying; 2) a group with constant pelvic pain unrelated to filling or emptying; and 3) patients complaining of urgency and frequency alone. No statistically significant responses were identified among the three groups.

The authors use hydrodistention in those patients who have failed trials with oral medications and continue to experience significant symptom morbidity. Thus, the population studied is somewhat skewed, but the results are a caution that hydrodistention rarely provides long-term (6 months or more) relief. Unfortunately identifying the patients who experienced relief in this study was not possible based on the symptom classification studied by the investigators. Eight patients had a Hunner's ulcer. They were evenly divided among the symptomatic groups, and responded no better than did their cohorts. Likewise, the severity of glomerulations was not related to results of distention.

The study shows efficacious response to distention of slightly over 50% of patients at the one month mark, dropping to 25% at 3 months. These are reasonable figures to quote to patients about to undergo hydrodistention under anesthesia for either diagnostic or therapeutic purposes.

Neurourology and Urodynamics 2005 November; 24:638-642