Journal List > Korean J Urol > v.49(10) > 1005208

Kim, Kim, and Oh: Characteristics of Pain and Change in the Severity of Pain after Hydrodistension in Patients with Interstitial Cystitis

Abstract

Purpose

Interstitial cystitis (IC) is characterized by severe irritating voiding symptoms as well as bladder pain without any specific causes in the bladder identified. Hydrodistension is offered as both a therapeutic and diagnostic tool in these patients. The goal of this study was to evaluate the bladder pain associated with IC as well as the severity of pain after hydrodistension in patients with IC.

Materials and Methods

Between October 2005 and October 2007, 34 patients with IC who underwent hydrodistension were included in the study. The baseline characteristics of the pain associated with IC and the severity of the pain after the hydrodistension were retrospectively evaluated using a questionnaire. Assessment was performed by one interviewer in a uniform manner using a pre-designed questionnaire. The severity of pain was graded using a 10-point pain scale (between 0 for none and 10 for the most severe pain that can be imaginable).

Results

Thirty four patients (9 men and 25 females) with a mean age of 57.8±12.9 (SD) years answered the questionnaire. The median duration of their follow-up was 12.0 (range; 4–36) months. The duration of pain before hydrodistension was a mean of 3.8 years (45.9±31.5 months). The patients reported a mean 8.0 points for bladder pain before hydrodistension and 1.7 points for one week, 2.0 for one month, 2.9 for three months, 4.3 for six months, 4.4 for nine months, and 5.3 for one year after the hydro-distension. The patients responded that they could tolerate their bladder pain up to a median of 2.0 (range; 0–8) points, and they reported that the relief of pain lasted for a median duration of 3.0 (range; 0–10) months after the hydrodistension.

Conclusions

Our results showed that hydrodistension was effective for relieving bladder pain after the procedure. However, its effect on pain decreased gradually over time, suggesting that hydrodistension has a therapeutic effect but these effects are time limited in patients with IC.

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Fig. 1.
Change in pain score after hydrodistension in patients with interstitial cystitis.
kju-49-931f1.tif
Table 1.
Cystoscopic findings at baseline and after hydrodistension (total 34 patients)
  Mean±SD Positive (%)
Outpatient-based baseline cystoscopy
Trabeculation (n)   2 (5.9)
Ulcer (n)   10 (29.4)
Hunner's lesion (n)   27 (79.4)
During and after acute hydrodistension
under anesthesia    
Volume at leakage (ml) 360.5±132.5 24 (70.6)
Maximal filling volume (ml) 460.0±112.3  
Hematuria at drainage   29 (85.3)
Glomerulation   32 (94.1)
Crack   30 (88.2)
During and after refilling hydrodistension
under anesthesia
Volume at leakage (ml) 386.7±120.4 15 (44.1)
Maximal filling volume (ml) 511.6±90.1  
Hematuria at drainage 26 (76.5)
Biopsy (sites) 1.7±0.9 33 (97.0)
Table 2.
Baseline characteristics of pain in 34 patients
Initial diagnosis at outside hospital  
Simple cystitis (%) 24/34 (70.5)
Psychogenic (%) 4/34 (11.8)
Prostatitis (%) 2/34 (5.9)
No diagnosis (%) 4/34 (11.8)
Sites of pain  
Urethra (%) 24/34 (70.6)
Bladder (%) 11/34 (32.4)
Vagina/Penile tip (%) 7/34 (20.6)
Perineum (%) 6/34 (17.6)
Suprapubis (%) 4/34 (11.8)
Rectum (%) 2/34 (5.9)
Pelvis (%) 1/34 (2.9)
Previous medication  
Antibiotics (%) 24/34 (70.6)
Sedatives/Analgesics (%) 9/34 (26.5)
Anticholinergics (%) 5/34 (14.7)
Elmiron (%) 4/34 (11.8)
Others (%) 4/34 (11.8)
Initial pain-inducing factor  
Fatigue/Insomnia (%) 8/34 (23.5)
Neurogenic (%) 7/34 (20.6)
Therapeutic procedures/operations (%) 4/34 (11.8)
Cystitis (%) 3/34 (4.3)
Sexual intercourse (%) 1/34 (2.9)
None (%) 14/34 (41.2)
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