BERKELEY, CA (UroToday Inc.) - Ottem and Teichman from Vancouver reported results of a retrospective review of 84 consecutive patients diagnosed with interstitial cystitis based on pain urgency frequency (PUF) questionnaire, history, physical examination, and 48 hour voiding diary, urinalysis, and urine culture. Cystoscopy with hydrodistention under anesthesia was performed in 47 patients. The mean patient age was 41 years, mean daily voided volume was 98ml, mean number of nocturnal episodes was 3, and pain urgency frequency score was 21. Pain was reported in 61% of those having distention versus 25% of those not distended. Vaginal pain, dyspareunia, and ejaculatory pain were also significantly more common in the distended group. Frequency, nocturia, duration of symptoms, voided volumes, and age was similar in the two groups. 56% of those distended experienced symptomatic improvement for a mean of 2 months. The authors conclude that cystoscopy with hydrodistension provided little useful information above and beyond the history and physical examination findings.

It is puzzling that one-third of the patients did not report pain. The study is retrospective and it is not clear why patients chose or did not choose distention, and how this was influenced by the physician. While I would agree with the conclusion reached, I don't think the study design itself answers the question in any way. To study this question, one would need a prospective design in which all patients underwent all relevant tests (including antiproliferative factor when available commercially), and statistical methods could be employed to determine the minimum data set needed to reliably select out the interstitial cystitis group. This may prove to be only history and urine culture, but that remains to be seen.

Urology, 2005 Sept; 66:494-499