Clinical Relevance of Bladder Histopathological Findings and Their Impact on Treatment Outcomes Among Patients With Interstitial Cystitis/Bladder Pain Syndrome: An Investigation of the European Society for the Study of Interstitial Cystitis Histopathologi

The current study aimed to investigate the clinical significance of European Society for the Study of Interstitial Cystitis (ESSIC) bladder histopathological classification and its impact on treatment outcomes among patients with interstitial cystitis/bladder pain syndrome (IC/BPS).

Bladder biopsy specimens obtained from severe, treatment refractory IC/BPS patients were analyzed by a single pathologist blinded to clinical data. Inflammatory cell infiltration and urothelium denudation, eosinophil infiltration, plasma cell infiltration, lamina propria hemorrhage, and granulation in specimens were evaluated separately. Patients with at least one histopathological finding were classified as ESSIC type C, with the rest being classified as ESSIC type A. Current overall treatment outcomes were determined via telephone interview.

Bladder specimens were obtained from 352 patients with IC/BPS. Bladder inflammation, urothelium denudation, eosinophil and plasma cell infiltration, lamina propria hemorrhage, and granulation were present in 69.6%, 44.6%, 9.1%, 15.3%, 4.8%, and 5.1% of the bladder specimens, respectively. Approximately 78.7% of the patients included herein were ESSIC type C and had a smaller cystometric bladder capacity and higher bladder pain compared to ESSIC type A. Although individual histopathological findings were not associated with treatment outcome, a higher proportion of ESSIC type A patients had worse, unchanged or < 25% improvement outcomes compared to ESSIC type C patients (43.1% vs. 25.8%; p = 0.025).

Bladder histopathological findings were associated with clinical parameters and differences in patients-reported treatment outcomes. Accordingly, patients with IC/BPS who had no remarkable bladder histopathological findings had less favorable treatment outcomes compared to those who did.

The Journal of urology. 2020 Aug 28 [Epub ahead of print]

Jia-Fong Jhang, Yung-Hsiang Hsu, Yuan-Hong Jiang, Han-Chen Ho, Hann-Chorng Kuo

Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan., Department of Pathology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan., Department of Anatomy, Tzu Chi University, Hualien, Taiwan.