較大的麻醉下膀胱容積可預測間質性膀胱炎病人接受膀胱水擴張治療之反應
蔡承翰1、范玉華1,2,3、林登龍1,2,3、黃志賢1,2,3
1台北榮民總醫院泌尿部
2國立陽明大學醫學院泌尿學科
3書田泌尿科學研究中心
Large Anesthetic Bladder Capacity is Predictive of Better Response to Hydrodistention in Interstitial Cystitis/Bladder Pain Syndrome
Cheng-Han Tsai1, Yu-Hua Fan1,2,3, Alex T. L. Lin1, 2,3, William J. Huang1, 2,3
1 Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
3Shu-Tien Urological Research Center, Taipei, Taiwan
Purpose:
Reported outcomes of hydrodistention for interstitial cystitis/bladder pain syndrome (IC/BPS) have various response rates making it difficult to standardize its clinical utility. We aim to better characterize clinical features involved in the symptomatic response to bladder hydrodistention. Therefore, we investigate the relationship between bladder capacity under anesthesia and treatment effectiveness in patients with IC/BPS who had undergone therapeutic bladder hydrodistention.
Materials and Methods:
We retrospectively reviewed medical records of female patients diagnosed with non-ulcerative IC/BPS who underwent bladder hydrodistension. All patients received preoperative assessment with 3-day voiding diaries and videourodynamic study. The O ́Leary – Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) questionnaires were administered to all patients prior to and one month after hydrodistention. Bladder capacity was measured during bladder hydrodistension under general anesthesia and large anesthetic bladder capacity was defined as a bladder volume of more than 650ml.
Results:
Of 75 IC/BPS patients enrolled in this study, 33 were compatible with large anesthetic bladder capacity. The evaluation of the individual items of the ICSI/ICPI questionnaires demonstrated that the improvement of subscore for bladder pain symptom (ICSI-Q4) after hydrodistention was significantly higher in patients with large anesthetic bladder capacity than those without (p = 0.04). The other subscores and total scores of the ICSI/ICPI questionnaires did not differ between the two groups. Patients with large anesthetic bladder capacity also had significantly larger median ± SE maximal voided volume recorded in the voiding diaries (265 ± 94.1 mL vs 200 ± 61.8 mL, p = 0.03). However, there was no significant difference in cystometric capacity between the patients with large anesthetic bladder capacity and those without. Similarly, the rate of positive KCL tests were not different between the two groups (84.6% vs 93.3%, p=0.4).
Conclusions:
IC/BPS patients with large anesthetic bladder capacity (>650 ml) are more likely to have bladder pain relief with hydrodistention alone.