Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan.
Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan.
J Urol. 2021 Jan;205(1):226-235. doi: 10.1097/JU.0000000000001334. Epub 2020 Aug 28.
We investigate the clinical significance of European Society for the Study of Interstitial Cystitis (ESSIC) bladder histopathological classification and its impact on treatment outcomes among patients with interstitial cystitis/bladder pain syndrome.
Bladder biopsy specimens obtained from severe, treatment refractory interstitial cystitis/bladder pain syndrome cases were analyzed by a single pathologist blinded to clinical data. Inflammatory cell infiltration and urothelium denudation, eosinophil infiltration, plasma cell infiltration, lamina propria hemorrhage and granulation in specimens were evaluated separately. Patients with at least 1 histopathological finding were classified as ESSIC type C, with the rest being classified as ESSIC type A. Current overall treatment outcomes were determined via telephone interview.
Bladder specimens were obtained from 352 patients with interstitial cystitis/bladder pain syndrome. Bladder inflammation, urothelium denudation, eosinophil and plasma cell infiltration, lamina propria hemorrhage and granulation were present in 69.6%, 44.6%, 9.1%, 15.3%, 4.8% and 5.1% of the bladder specimens, respectively. Approximately 78.7% of the patients included were ESSIC type C and had a smaller cystometric bladder capacity and higher bladder pain compared to ESSIC type A. Although individual histopathological findings were not associated with treatment outcome, a higher proportion of ESSIC type A patients had worse, unchanged or less than 25% improvement outcomes compared to ESSIC type C (43.1% vs 25.8%, p=0.025).
Bladder histopathological findings were associated with clinical parameters and differences in patient reported treatment outcomes. Accordingly, patients with interstitial cystitis/bladder pain syndrome who had no remarkable bladder histopathological findings had less favorable treatment outcomes compared to those who did.
我们研究欧洲尿石症研究协会（ESSIC）膀胱组织病理学分类的临床意义及其对间质性膀胱炎/膀胱疼痛综合征患者治疗结果的影响。
对严重、治疗抵抗的间质性膀胱炎/膀胱疼痛综合征病例的膀胱活检标本进行分析，由一名对临床数据不知情的病理学家进行。单独评估标本中的炎症细胞浸润和尿路上皮脱落、嗜酸性粒细胞浸润、浆细胞浸润、固有层出血和肉芽组织形成。至少有 1 种组织病理学发现的患者被归类为 ESSIC 型 C，其余患者被归类为 ESSIC 型 A。通过电话访谈确定当前的总体治疗结果。
共获得 352 例间质性膀胱炎/膀胱疼痛综合征患者的膀胱标本。膀胱炎症、尿路上皮脱落、嗜酸性粒细胞和浆细胞浸润、固有层出血和肉芽组织形成分别见于 69.6%、44.6%、9.1%、15.3%和 5.1%的膀胱标本。大约 78.7%的患者为 ESSIC 型 C，与 ESSIC 型 A 相比，其膀胱容量较小，膀胱疼痛程度较高。尽管个别组织病理学发现与治疗结果无关，但与 ESSIC 型 C 相比，更多的 ESSIC 型 A 患者的治疗结果较差、不变或改善不足 25%（43.1%比 25.8%，p=0.025）。
膀胱组织病理学发现与临床参数和患者报告的治疗结果差异相关。因此，与有明显膀胱组织病理学发现的间质性膀胱炎/膀胱疼痛综合征患者相比，无明显膀胱组织病理学发现的患者的治疗结果较差。
