膀胱鏡水擴張術的特徵提供治療後間質性膀胱炎的臨床和長期預後特徵

李雨霜、張嘉峰、劉民慶、楊家誠、黃子修、張天霖、陳聖復、江元宏、游婉茹、郭漢崇

花蓮慈濟醫院 泌尿科

Cystoscopic hydrodistention characteristics provide clinical and long-term prognostic features of interstitial cystitis after treatment

Yu-Shuang Lee, Jia-Fong Jhang, Min-Ching Liu, Chia-Cheng Yang, Tsu-Hsiu Huang, Tien-Lin Chang, Sheng-Fu Chen, Yuan-Hong Jiang, Wan-Ru Yu, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Hualien, Taiwan

Purpose: To evaluate the correlations of clinical symptoms, urodynamic parameters, and long-term treatment outcomes with different findings of cystoscopic hydrodistention (HD) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS).

Materials and Methods: This retrospective analysis of 486 patients with IC/BPS investigated baseline clinical symptoms, disease duration, medical comorbidities, urodynamic findings, cystoscopic characteristics (including maximal bladder capacity [MBC] and the presence of glomerulations and Hunner’s lesions), and outcomes according to the five IC/BPS HD subtypes based on the glomerulation grade, MBC, and the presence of Hunner’s lesions.

Results: Receiver operation characteristic analysis identified an optimal cutoff value of MBC≥760 ml as a predictor of satisfactory outcomes. Glomerulation grade and MBC were significantly correlated (r= – 0.403, P < 0.001), and both were significantly associated with IC Symptom Index scores. Glomerulations grade is also correlated with severe symptoms and bladder conditions. The rate of satisfactory outcomes was better for the patients with low glomerulation grade and MBC ≥760 ml (64.2%), and significantly worse for those with Hunner’s lesions (36.8%); no significant differences were noted among the other groups. The results suggested that IC/BPS patients can be classified into the following three distinct subgroups: (1) those with low glomerulation grade and MBC ≥760 ml; (2) those with low glomerulation grade and MBC <760 ml, or with high glomerulation grade regardless of MBC; and (3) those with Hunner’s lesions.

Conclusions: The results showed that three IC/BPS subgroups had distinct bladder characteristics and treatment outcomes. The patients with high MBC and low glomerulation grade after HD had more medical comorbidities but a significantly higher rate of satisfactory treatment outcome.