Hsu Lin-Nei, Tsai Yuh-Shyan, Tong Yat-Ching
Department of Urology, An Nan Hospital, China Medical University, Tainan City, Taiwan, ROC.
Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
Neurourol Urodyn. 2022 Jan;41(1):296-305. doi: 10.1002/nau.24818. Epub 2021 Oct 11.
The role of hydrodistension in the diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) is controversial. This study evaluated the effect of low-pressure hydrodistension on glomerulation formation in female patients diagnosed with the disease.
Sixty female patients with the clinical diagnosis of IC/BPS and 30 female controls without the disease underwent cystoscopy and hydrodistension. Cold-cup biopsy was taken from bladder posterior wall at sites with normal cystoscopic appearance before hydrodistension in the IC/BPS group. The tissue samples were processed for histology study. Low-pressure (40 cmH O) hydrodistension for 2 min was performed and the appearance of glomerulations was compared between the two groups. High-pressure (80 cmH O) hydrodistension for 8 min was then performed as a therapeutic measure for the IC/BPS patients. Further changes to the degree of glomerulations were recorded.
Histology showed pathological changes in the normal-appearing IC/BPS bladder mucosa including urothelium denudation, inflammatory cell infiltration, stromal edema, fibrosis, and vascular congestion. Low-pressure hydrodistension induced significant glomerulation formation in the patient group (percentage of patients with Grades 0-4: 0%, 8.3%, 40%, 35%, 10%, respectively) while none in the controls. High-pressure hydrodistension further increased the glomerulation grading in the IC/BPS patients.
Structural changes are present in prehydrodistension IC/BPS bladder wall, which may not be macroscopically detectable. Hydrodistension at low pressure is adequate to disrupt the integrity of such diseased mucosa and offers a more discriminative test in the diagnosis of IC/BPS.
膀胱水扩张术在间质性膀胱炎/膀胱疼痛综合征（IC/BPS）诊断中的作用存在争议。本研究评估了低压膀胱水扩张术对诊断为该病的女性患者肾小球样改变形成的影响。
60例临床诊断为IC/BPS的女性患者和30例未患该病的女性对照者接受了膀胱镜检查和水扩张术。在IC/BPS组中，于水扩张术前在膀胱后壁外观正常的部位进行冷杯活检。对组织样本进行组织学研究。进行2分钟的低压（40cmH₂O）水扩张术，并比较两组之间肾小球样改变的表现。然后对IC/BPS患者进行8分钟的高压（80cmH₂O）水扩张术作为治疗措施。记录肾小球样改变程度的进一步变化。
组织学显示外观正常的IC/BPS膀胱黏膜存在病理改变，包括尿路上皮剥脱、炎性细胞浸润、间质水肿、纤维化和血管充血。低压水扩张术在患者组中诱导了显著的肾小球样改变形成（0-4级患者的百分比分别为0%、8.3%、40%、35%、10%），而对照组中无此现象。高压水扩张术进一步提高了IC/BPS患者的肾小球样改变分级。
水扩张术前IC/BPS膀胱壁存在结构改变，这些改变可能在宏观上无法检测到。低压水扩张术足以破坏这种病变黏膜的完整性，并在IC/BPS的诊断中提供更具鉴别性的检测。
