Interstitial Cystitis / Bladder Pain Syndrome: factors predicting the clinical course of the disease

Abstract

Introduction. Etiology of the Bladder pain syndrome/Interstitial cystitis (BPS/IC) remains completely unknown. BPS/ IC is a chronic disease in which bladder biopsy specimens show varying degrees of inflammation`s severity, detrusor fibrosis and mastocytosis. With BPS/IC, cellular mechanisms of inflammation and processes leading to tissue damage and fibrosis are still not entirely clear. However, the results of studies have shown that fibrosis and mastocytosis of the detrusor are associated with the need for various types of treatment and suggest the failure of standard therapy.Purpose of research. The aim of the study is to determine the relationship between the anatomical capacity of the bladder and detrusor fibrosis with the clinical course of BPS/IC.Materials and methods. 110 patients with BPS/IC were examined from 2010 to 2014 in the University Urological Clinic MSMU, A.I. Evdokimov Moscow State University of Medicine and Dentistry. Patients` pain severity was assessed by a 10-point Visual Analogue Pain scale (VAS). Clinical manifestations of the disease were assessed using international questionnaires: an index of symptoms and quality of life of patients with interstitial cystitis (Interstitial Cystitis Symptom and Problem Indexes; ICSI, ICPI) and scales of symptoms of pelvic pain, urgency and frequency of urination (the Urine and Frequency Questionnaire, PUF), Female Sexual Dysfunction Index (FSDI), Hospital Anxiety and Depression Scale. All patients underwent cystoscopy with general anesthesia for therapeutic and diagnostic purposes. Bladder biopsy was performed in 36 patients (33%) for the treatment of other bladder`s diseases, as well as for the degree`s pathological assessment of the inflammatory process and the severity of detrusor fibrosis.Results. In 65% of patients, the anatomical capacity of the bladder was 200-350 ml, and in 5% of cases, its reduction to 100 ml was found. The average capacity of the bladder was 297 ± 90.2 ml. The results of the study suggest a significant decrease in the anatomical capacity of the bladder due to progressive inflammation and fibrosis in the bladder`s wall an essential factor affecting the clinical course of the BPS/IC, causing the severity of the organ-specific symptoms of the disease. A direct correlation was found between the indicators of the nature of alterative changes in urothelia, the severity of inflammatory infiltration and the severity of pain, symptoms of dysuria, in particular, frequency of urination and imperative urges, quality of life and mental health. The severity of fibrosis, the presence of perineuritis and mastocytosis are directly dependent on the duration of the disease.Conclusions. Reduced bladder capacity and detrusor fibrosis are markers of bladder damage in BPS/IC. These changes are characteristic of a certain patients` subgroup who require endovesical treatment, unlike patients with a systemic phenotype and comorbid conditions.

Keywords

• bladder pain syndrome/interstitial cystitis
• detrusor fibrosis
• fibrogenesis
• bovgialuronidase azoxymere