以點狀出血(glomerulations)與最大膀胱容量為基礎的間質性膀胱炎/膀胱疼痛症候群表型和臨床特徵之相關性

郭育成、郭漢崇¹

臺北市立聯合醫院泌尿科；¹佛教慈濟綜合醫院與慈濟大學泌尿部

Correlation of IC/BPS phenotype based on glomerulations and MBC subgroups and clinical characteristics. 

Yuh-Chen Kuo, Hann-Chorng Kuo¹

Department of Urology, Taipei City Hospital, Taipei, Taiwan;

Department of Urology¹, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

Purpose: Maximal bladder capacity (MBC), grade of glomerulations (Glom) and presence of Hunner’s ulcer are the three major findings/parameters of cystoscopic hydrodistention used for diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS). Based on the finding on Hunner’s ulcer, IC/BPS has been traditionally classified into the ulcer type and non-ulcer type which have been considered as two distinct diseases. However, the role of other two cystoscopic parameters (MBC and Glom) on the clinical characters of IC/BPS has not been elucidated. We investigated the correlations between clinical variables and the phenotype based on Glom and MBC subgroups in IC/BPS patients.

Materials and Methods: IC/BPS patients who have undergone cystoscopic hydrodistention were retrieved from a database containing 496 subjects. According the severity of Glom (grade 0, 1, 2, 3, 4) and MBC (>=760 or <760 ml) measured during hydrodistention, the patients were categorized into five phenotypes (PTs): PT1) Glom=0/1, MBC>=760. PT2) Glom=0/1, MBC<760. PT3) Glom=2/3, MBC>=760. PT4) Glom=2/3, MBC<760. PT5) Glom=4 (ulcer type). Clinical variables including age, gender, disease duration, prevalence of various functional somatic syndromes, number of medical comorbidities, IC symptom scores, urodynamic study (UDS) parameters such as first sensation of filling (FSF), first desire to void (FD), strong desire to void (SD), maximum flow rate (Qmax), detrusor pressure at Qmax (Pdet), voided volume, postvoid residual volume (PVR), cystometry bladder capacity (CBC) and compliance, and video UDS diagnoses, result of potassium sensitivity test (PST) and long-term treatment outcome were analyzed and compared among the five IC/BPS phenotypes.

Results: A total of 488 IC/BPS patients (male:female=65:423; mean age, 58.8±13.8; mean duration: 13.6±9.8 years; mean follow-up: 5.8± 5.1 years) were included in this study. There were significant differences in mean age, distributions of psychosomatic disorder (PSD) and arrhythmia and number of comorbidities among the five IC/BPS PTs (Table). PT5 had the oldest age and highest prevalence in PSD while PT1 and PT3 had the highest prevalence in arrythmia. The mean number of comorbidities decreased from PT1 through PT4. In addition, the mean IC symptom scores increased from PT1 to PT5. The UDS storage parameters (FSF, FD, SD, CBC, volume) and compliance decreased from PT1 to PT5. Also, the prevalence of hypersensitive bladder (HSB) increased from PT1 to PT5. There was no significant difference in distributions of gender, duration, video UDS diagnoses, result of PST and long-term treatment outcome among the five PTs.

Conclusions: This study demonstrated the novel IC/BPS phenotype system based on the severity of bladder pathology (Glom and MBC subgroups) was correlated well with the symptom scores, UDS storage parameters and compliance, and prevalence of HSB, providing a valuable tool for clinical description and patient counseling.