BERKELEY, CA (UroToday.com) - Interstitial cystitis (IC) is characterized by chronic urinary urgency, frequency, and/or pelvic pain in the absence on any known etiology. In 1987, urologists adopted and began using certain criteria to aid in the diagnosis of the condition. One of these criteria involved findings observed during cystoscopy with hydrodistension including assessment of bladder volume and the presence and appearance of glomerulations. Many clinicians believed that the criteria were too restrictive and wrongly exclude many patients from the diagnosis.

A recent study from D. P. Ottem and colleagues from Vancouver, British Columbia focused on two research questions: whether cystoscopy with hydrodistension adds any diagnostic information beyond that of the clinical evaluation, and whether the procedure offers any therapeutic benefit. The study is published in the September 2005 issue of Urology.

A total of 84 patients with interstitial cystitis (68 women and 16 men) with a mean age of 41 years comprised the study group. The diagnosis of IC was made by standardized history, physical examination, and 48-hour voiding diary findings, unremarkable urinalysis and urine culture findings, and the results of a pain urgency frequency (PUF) questionnaire. Patients had a mean duration of symptoms of 6 years, had a mean number of nocturia episodes of 3, daily voiding frequency of every 63 minutes, with a mean voided volume of 98 ml during the day. The mean PUF score was 21 (range 10 to 32). All patients reported pain or pressure localized to the suprapubic area in 75%, the urethra or penis in 73%, vagina in 65% of the women, and testes in 25% of the men. Of this group, 47 patients underwent cystoscopy with hydrodistension. The mean hydrodistension volume was 729 cc and 43 of these patients had a mean follow-up of 5 months.

Analysis of the results showed that when comparing patients undergoing versus not undergoing hydrodistension, pain was reported in 61% versus 25%, vaginal pain in 62% versus 32%, and dyspareunia or ejaculatory pain in 67% versus 29%, respectively. Of the 56% of patients that reported improvement with the procedure, the mean duration of symptomatic benefit was only 2 months. Of the patients with and without improvement, no difference was found in mean age, duration of symptoms, and anesthetic capacity of severity of glomerulations.

In summary, the authors suggest that cystoscopy with hydrodistension provided little useful information above and beyond the history and physical exam findings. As a therapy, 56% of the patients reported improvement, but the duration was very short lived. The condition of IC remains largely a clinical diagnosis, and cystoscopy is indicated to exclude bladder cancer as appropriate but should not be expected to provide long-term therapeutic relief.

Urology. 2005 Sep; 66(3):494-9