NEW YORK (Reuters Health) - Interstitial cystitis is highly prevalent in women with chronic pelvic pain, US researchers have found. They recommend that two office-based tools, the Interstitial Cystitis Symptom Index and a visual analog scale for dyspareunia, be used to screen for this condition.

Prior to the study, the Interstitial Cystitis Symptom Index and Problem Index had been validated in women already diagnosed with interstitial cystitis, but they had not been evaluated as screening tests. Dr. Jeffrey L. Clemons, a urogynecology fellow at Brown University School of Medicine, Providence, Rhode Island, and colleagues administered the indexes to 45 women with chronic pelvic pain (duration 6 to 120 months, mean 71 months).

The patients also underwent diagnostic laparoscopy and cystoscopy with hydrodistension. Seventeen of them (38%) met the predetermined criteria for interstitial cystitis: urinary urgency, urinary frequency (eight or more voids while awake) or nocturia (two or more voids each night), and glomerulations or a Hunner's ulcer on cystoscopy.

"It is unlikely that this high prevalence of interstitial cystitis is a result of selection bias," the authors note in the August issue of Obstetrics and Gynecology, "because women with chronic pelvic pain were recruited from general gynecology attending physicians and not from a urogynecology or urology division."

In this population, the Problem Index was not strongly associated with a diagnosis of interstitial cystitis. A score of 5 or more on the Symptom Index was an independent predictor of interstitial cystitis with a sensitivity of 94%, a specificity of 50%, a positive predictive value of 53%, and a negative predictive value of 93%.

Dyspareunia of 7 or more, on a visual analog scale from 0 to 10, was also an independent predictor of interstitial cystitis. A confounding effect of endometriosis was unlikely, the authors explain, because there was no significant association between interstitial cystitis and endometriosis.

For women who had both a high score on the Symptom Index and an elevated dyspareunia score, the probability of being diagnosed with interstitial cystitis was 72% (odds ratio 14.9). "If either risk factor is present," Dr. Clemons and his associates suggest, "cystoscopy with hydrodistension should be considered at the time of laparoscopy."

They add that there was no correlation between interstitial cystitis and the laparoscopic findings, so "it is not possible to suggest that cystoscopy is necessary only if the laparoscopy is negative, or to suggest that cystoscopy is unnecessary if endometriosis or other pelvic pathology is found."

Obstet Gynecol 2002;100:337-341.

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