AIMS - To evaluate the correlation between symptom severity of bladder pain syndrome/interstitial cystitis (BPS/IC) and autonomic nervous system activity, we examined autonomic responses during bladder hydrodistention.
METHODS - Medical records were collected from a prospective database for patients who underwent bladder hydrodistention with a fixed protocol from March 2012 to December 2013. A total of 40 patients (16 males, 24 females) were included for the analysis. Hydrodistention was performed under general anesthesia (31 patients), spinal anesthesia (six patients), and both types of anesthesia (three patients) at different times. Twenty-five patients who underwent holmium laser enucleation of the prostate served as controls. Pulse rate (PR), systolic (SBP), and diastolic blood pressure (BP) were measured pre-hydrodistention, during hydrodistention, and after drainage.
RESULTS - The spinal anesthesia and control groups exhibited little change in BP and PR during hydrodistention, while a significant increase was demonstrated in the general anesthesia group (e.g., ΔSBP 4.89 ± 4.80, 10.40 ± 19.03, and 56.26 ± 30.38 mm Hg, respectively, P < 0.001). Under general anesthesia, autonomic response during hydrodistention was more prominent in patients with preoperative visual analogue scale (VAS) pain score ≥7, Hunner's lesion, and glomerulation grade 4. Preoperative maximal cystometric capacity negatively correlated with changes in SBP during hydrodistention (R(2) = 0.294, P = 0.009), while VAS score and interstitial cystitis problem index demonstrated a positive correlation with the changes (R(2) = 0.208, P = 0.012; R(2) = 0.173, P = 0.015).
CONCLUSIONS - Under general anesthesia, exaggerated autonomic responses to bladder hydrodistention were demonstrated in BPS/IC patients, which reflected the severity of symptoms. These results support the hypothesis of altered activity of autonomic system in BPS/IC. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.
Neurourology and urodynamics. 2016 Mar 29 [Epub ahead of print]
Sang Woon Kim, Hee Seo Son, Irela Soto Troya, Ji Yu Kim, Myoung Joo Kim, Matthew O Fraser, Jang Hwan Kim
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Veterans Affairs Medical Center, Durham, North Carolina., Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.