BERKELEY, CA (UroToday Inc.) - Chronic pelvic pain (CPP) is an enigmatic disease which affects millions of women. The etiology of the pain is often not clear, and many women undergo hysterectomy in hopes of alleviating their symptoms. The number of women with CPP who have undergone a hysterectomy and continue to have pain which may be due to interstitial cystitis (IC) is not known.

Dr. Maurice Chung from the Midwest Regional Center for Chronic Pelvic Pain in Lima, Ohio investigated the prevalence of IC in patients who have undergone hysterectomy for CPP. He also evaluated the efficacy of various treatments for IC in these patients.

His findings were published in the October-December 2004 edition of the Journal of the Society of Laparoendoscopic Surgeons. He studied 111 women who had persistent CPP after hysterectomy done with or without oophorectomy. These patients completed the Pelvic Pain and Urgency/Frequency symptoms scale (PUF), and underwent a potassium sensitivity test of the bladder (PST) and physical examination. All patients also underwent behavioral training with dietary counseling. Those who had a negative PST but had severe pelvic pain, also underwent cystoscopic hydrodistention (CH), while those with positive PST were also offered CH, pentosan polysulfate (PPS) 200 mg, or a combination of the two. Patients were followed for at least 6 months.

94% (104/111) of the patients had irritative voiding symptoms and the mean PUF score was 14.5. 79% (88/111) had a positive PST along with symptoms consistent with IC.

Those with presumed IC (n=88) had the following treatments including dietary modifications: 26% diet changes alone, 4 % CH, 10% PPS, and 60% CH and PPS.

Overall, a decrease in PUF score, indicating symptom improvement, was seen. The PUF score in patients who underwent dietary modification alone went from 13.18 to 11.15 and in those undergoing additional treatment with CH and/or PPS decreased from 15.01 to 9.87.

The author concludes that it is necessary for gynecologists to rule out non-gynecologic causes for CPP prior to performing a hysterectomy for treatment. In addition, those who are diagnosed with IC using the PUF scale and PST as screening may have adequate relief of pain symptoms after undergoing dietary modification, CH, or PPS, or a combination of treatments, thereby preventing possible unnecessary surgery.

JSLS 2004; 8:329-333