膀胱镜检查伴水扩张和随机活检在临床疑似间质性膀胱炎/膀胱疼痛综合征中的诊断和治疗效果。

The diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies in clinically suspected interstitial cystitis/bladder pain syndrome.

机构信息

Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2021 Oct;265:156-161. doi: 10.1016/j.ejogrb.2021.08.025. Epub 2021 Aug 27.

DOI:10.1016/j.ejogrb.2021.08.025

PMID:34492610

Abstract

OBJECTIVE

We aimed to explore the diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies for clinically suspected interstitial cystitis/bladder pain syndrome (IC/BPS).

STUDY DESIGN

We reviewed the data of fifty-five clinically suspected IC/BPS patients underwent cystoscopy with hydrodistension and random biopsies. Global Response Assessment was used to evaluate the efficacy. Disease severity was assessed by thorough history, physical examination, 3-day frequency volume chart, visual analog scale of pain, Interstitial Cystitis Symptom Index (ICSI) and clinical phenotype system (UPOINT).

RESULTS

According to the pathologic outcomes from random biopsies, three out of the 55 clinically suspected IC/BPS were diagnosed as bladder carcinoma. Among the 52 IC/BPS patients, thirty-six patients (69.2%) had initial chief complaints of urinary frequency and urgency. Under cystoscopy, twenty-nine patients and 23 patients were classified as Hunner ulcer type and diffuse global mucosal bleeding (grade III glomerulation). The median functional bladder capacity of the 52 IC/BPS patients was 100 ml. Hydrodistension was effective in 28 patients (53.8%) at postoperative 3 months, which decreased to 25% at post-hydrodistension 6 months and to 13.5% at 12 months. For the 28 hydrodistension-effective patients, the remission degrees of daytime frequency, nocturia, VAS bladder pain and ICSI score were 50.3%, 49.4%, 68.1% and 48%, which were significantly higher than the 16.9% (daytime frequency, P < 0.001), 20.5% (nocturia, P = 0.021), 7.4% (VAS pain score, P < 0.001) and 6.1% (ICSI, P < 0.001) in the hydrodistension-negative group. According to the UPOINT system, the hydrodistension-effective cases had significantly higher rates of symptom remission in U (P = 0.002), P (P = 0.026), O (P < 0.001), and T (P < 0.001) domains than the corresponding negative cases. In effective group, the O domain had the most remission rate (26 out of 28, 92.9%, P < 0.001), followed by the U domain (12 out of 28, 42.9%, P < 0.001) and T domain (12 out of 28, 42.9%, P < 0.001).

CONCLUSION

Histopathological analysis from random biopsies could distinguish bladder carcinoma from clinically suspected IC/BPS. Hydrodistension is more likely to be effective when chronic pelvic pain is obviously alleviated. The efficacy of hydrodistension could act in a certain period of time.

摘要

目的

探讨膀胱镜下注水扩张及随机活检对疑似间质性膀胱炎/膀胱疼痛综合征（IC/BPS）患者的诊断和治疗效果。

研究设计

我们回顾了 55 例疑似 IC/BPS 患者接受膀胱镜下注水扩张及随机活检的资料。采用整体反应评估（GRA）来评估疗效。通过详细的病史、体格检查、3 天频率-容量图表、疼痛视觉模拟评分（VAS）、间质性膀胱炎症状指数（ICSI）和临床表型系统（UPOINT）来评估疾病严重程度。

结果

根据随机活检的病理结果，55 例疑似 IC/BPS 患者中有 3 例被诊断为膀胱癌。在 52 例 IC/BPS 患者中，36 例（69.2%）最初的主要症状为尿频和尿急。在膀胱镜检查下，29 例和 23 例患者被分为 Hunner 溃疡型和弥漫性全层黏膜出血（III 级肾小球）。52 例 IC/BPS 患者的平均功能性膀胱容量为 100ml。术后 3 个月，28 例（53.8%）患者的扩张治疗有效，术后 6 个月降至 25%，术后 12 个月降至 13.5%。在 28 例扩张治疗有效的患者中，日间尿频、夜间多尿、VAS 膀胱疼痛和 ICSI 评分的缓解程度分别为 50.3%、49.4%、68.1%和 48%，显著高于扩张治疗无效组的 16.9%（日间尿频，P<0.001）、20.5%（夜间多尿，P=0.021）、7.4%（VAS 疼痛评分，P<0.001）和 6.1%（ICSI，P<0.001）。根据 UPOINT 系统，扩张治疗有效的病例在 U（P=0.002）、P（P=0.026）、O（P<0.001）和 T（P<0.001）领域的症状缓解率明显高于相应的阴性病例。在有效组中，O 域的缓解率最高（28 例中有 26 例，92.9%，P<0.001），其次是 U 域（28 例中有 12 例，42.9%，P<0.001）和 T 域（28 例中有 12 例，42.9%，P<0.001）。