Bladder pain syndrome/interstitial cystitis in contemporary UK practice: Outcomes of phenotype-directed management
| Autor: | Arun Sahai, Sachin Malde, Nabiah Malik, Claire Taylor, Anoushka Neale |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Cystitis Interstitial Disease Lesion 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine medicine Prevalence Humans Aged Retrospective Studies Aged 80 and over 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry Interstitial cystitis Magnetic resonance imaging Cystoscopy Middle Aged Ablation medicine.disease United Kingdom Treatment Outcome Neurology Cohort Histopathology Female medicine.symptom business |
| Zdroj: | Lower urinary tract symptomsREFERENCES. 13(1) |
| ISSN: | 1757-5672 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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