and Objectives: Identification of Hunner's lesions in IC/BPS patients presents an opportunity for objective classification into those with Hunner's lesion IC/BPS (classic IC) and those with non-Hunner's lesion BPS. While currently a diagnosis of Hunner's lesion IC/BPS requires cystoscopy, limited data exists suggesting that these subtypes can be distinguished without endoscopic examination based on the degree of bladder-focused centricity and infrequent association with generalized pain conditions.
Patients from a prospective single-center database of IC/BPS patients who had documented cystoscopic findings were categorized as those with Hunner's lesion IC/BPS and non-Hunner's lesion BPS. Their demographics, pain and symptom scores, voiding symptoms, presence of IBS, and clinical UPOINT scoring were comparatively analyzed.
A total of 469 patients were reviewed. Of those, 359 had documented local anesthetic cystoscopic findings; 44 (12.3%) with Hunner's lesion IC/BPS and 315 (87.7%) with non-Hunner's BPS. Patients with Hunner's lesions were older (p=0.004), had greater urinary frequency (p=0.013), more nocturia (p=0.0004) and higher ICSI scores (p=0.017). Prevalence of Hunner's lesions was significantly higher in those <50 years old (7.8%) compared to those aged 50 and older (14.9%; p=0.0095). There was no difference in number of UPOINT phenotype domains reported, overall UPOINT scores or prevalence of IBS between the groups.
A subtype of IC with Hunner's lesions has worse bladder-centric symptoms, but did not have a distinct bladder-centric phenotype. Given the management implications of distinguishing classic IC from non-Hunner's lesion BPS, we recommend cystoscopy with local anesthesia for patients diagnosed with IC/BPS.
The Journal of urology. 2016 Apr 23 [Epub ahead of print]
R Christopher Doiron, Victoria Tolls, Karen Irvine-Bird, Kerri-Lynn Kelly, J Curtis Nickel
Department of Urology, Queen's University, Kingston, Canada., Department of Urology, Queen's University, Kingston, Canada., Department of Urology, Queen's University, Kingston, Canada., Department of Urology, Queen's University, Kingston, Canada., Department of Urology, Queen's University, Kingston, Canada. Electronic address: .