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Bladder pain syndrome/interstitial cystitis in contemporary UK practice: Outcomes of phenotype‐directed management
Author(s) -
Neale Anoushka,
Malik Nabiah,
Taylor Claire,
Sahai Arun,
Malde Sachin
Publication year - 2021
Publication title -
luts: lower urinary tract symptoms
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.451
H-Index - 15
eISSN - 1757-5672
pISSN - 1757-5664
DOI - 10.1111/luts.12343
Subject(s) - interstitial cystitis , medicine , bladder pain syndrome , magnetic resonance imaging , cystoscopy , retrospective cohort study , cohort , pelvic pain , ablation , urology , surgery , radiology , urinary system
Objectives Problem bladder pain syndrome/interstitial cystitis (BPS/IC) is a heterogeneous disorder with variation in management worldwide. Phenotyping aims to personalize therapy and optimize outcomes. The most well‐described phenotype is Hunner lesion disease (HLD). The prevalence of HLD and outcome of phenotype‐directed management in the UK is not well‐studied. We describe the management of a contemporary cohort of patients with BPS/IC in the UK. Methods Retrospective analysis of all patients with BPS/IC from January 2015‐November 2018. Outcomes of patients who underwent laser ablation to Hunner lesions were collected using the Global Response Assessment tool. Results One hundred and sixty‐three patients (mean age of 43 years [20–85]) were included. 78% were female and patients had experienced symptoms for an average 6 years (1–30) prior to specialist assessment. Eighty‐three percent of patients had pelvic imaging (44% ultrasound, 42% magnetic resonance imaging and 14% computed tomography), and a relevant abnormality was found in five (4%). Twenty‐two patients (14%) had HLD (International Society for the Study of BPS [ESSIC] 3), with a mean bladder capacity of 373 mL (175‐650 mL); 77% were ESSIC C on histopathology. All patients with HLD underwent laser ablation, with 55% experiencing a moderate/marked improvement in symptoms, with a mean duration of effect of 10 months (3–36); 27% of patients had a repeat treatment. Conclusions The presence of HLD in patients with BPS/IC is not uncommon. Pelvic imaging rarely identifies any cause for pain and so cystoscopy under anesthesia is essential for accurate phenotyping. Phenotype‐directed management with holmium laser ablation to Hunner lesions has good short‐term efficacy in improving pain, but re‐intervention is often required.