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AUA 2019

AUA 2019: Characterization of the “End Stage Bladder” in Chronic Cystitis

Chicago, IL (UroToday.com) This was a retrospective cohort study evaluated patients with cystitis referred to a tertiary care center for refractory symptoms. Interstitial Cystitis (IC), Bladder Pain Syndrome (BPS), eosinophilic cystitis and non-malignant causes of chronic cystitis who demonstrated more than one of: severely reduced bladder capacity; diffuse mucosal loss; new VUR or loss of compliance were included. Patients with a history of pelvic radiation, urologic malignancy, neurogenic bladder or neurologic disease were excluded. The purpose of this study is to phenotype these patients and describe the disease process.

There were 75 patients with chronic cystitis were identified and after exclusions, 30 were included in the study from 2008-2018, 75 patients with chronic cystitis were identified and after exclusions, 30 were included in the study. Most patients were female (n=25, 83%) and Caucasian (n=27, 90%) and had never used tobacco (n=20, 67%). The most frequent comorbidities included asthma (n=19, 63%), anemia (n=17, 57%) and hypertension (n=18, 60%).

The median age of onset of bladder symptoms was 63 years (IQR 47,68) and the primary presenting symptom was most often incontinence (n=9, 30%), recurrent urinary tract infections (n=8, 27%) or Urgency/frequency (n=7 23%). The median maximum bladder capacity was 67 mL (IQR 30, 150). At presentation, imaging showed hydronephrosis in 33% (n=10) and VUR in 40% (n=12). Bladder pathology revealed inflammation in most (n=22, 73%), followed by ulcerated (n=15, 50%) or denuded epithelium (n=10, 33%); Eosinophilic cystitis was rare (n=4, 13%). Median follow-up was 18 months (IQR 8,48). At time of the most recent clinical encounter, 25 (83%) patients had undergone urinary diversion. The median time from presentation to urinary diversion was 2 years (IQR 1,8). Age at onset was found to be correlated to proceeding to urinary diversion (p=0.01), however no significant correlation was found between need for urinary diversion and the length of symptom duration or bladder capacity.

In this cohort of patients with End Stage Chronic Cystitis, 83% ultimately required urinary diversion within 2 years of symptom onset. Age at onset was correlated with need for urinary diversion. Larger cohort studies are required to draw conclusions regarding factors predisposing to this severe phenotype

Presented by: Giulia Lane, MD Michigan Medicine, Department of Urology, Ann Arbor, Michigan

Written by: Bilal Farhan, MD, Clinical Instructor, Female Urology and Voiding Dysfunction, Department of Urology, University of California, Irvine @BilalfarhanMD at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois