FEMALE UROLOGY

What is the value of cystoscopy with hydrodistension for interstitial cystitis?
Ottem DP, Teichman JM
Division of Urology, Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada
Urology. 2005; 66: 494-9

• Objectives: To determine the utility of cystoscopy with hydrodistension for the diagnosis and therapy of interstitial cystitis. Cystoscopy with hydrodistension is the most commonly performed diagnostic test and procedure in patients with interstitial cystitis.
• Methods: Eighty-four consecutive patients with interstitial cystitis (68 women and 16 men) were studied retrospectively. The patients underwent history and physical examination, urinalysis, and urine culture and filled in a voiding diary and pain urgency frequency questionnaire. Cystoscopy with hydrodistension was performed in 47 patients. Patients who had and had not undergone hydrodistension were compared. Patients who underwent hydrodistension were characterized and followed up for response.
• Results: The mean patient age was 41 years, mean daily voided volume was 98 mL, mean number of nocturnal episodes was 3, and pain urgency frequency score was 21. Comparing patients undergoing versus not undergoing hydrodistension, pain was reported in 61% versus 25% (P = 0.03), vaginal pain in 62% versus 32% (P = 0.02), and dyspareunia or ejaculatory pain in 67% versus 29% (P < 0.01), respectively. All other parameters were statistically similar. Of the patients undergoing hydrodistension, 43 had follow-up and 24 (56%) reported improvement (mean duration of 2 months). Of the patients with and without improvement, no difference was found in mean age (40 versus 46 years, P = 0.20), duration of symptoms (7 versus 7 years, P = 0.92), anesthetic capacity (722 versus 721 mL, P = 0.99), or glomerulation grade (P = 0.61), respectively.
• Conclusions: Cystoscopy with hydrodistension provided little useful information above and beyond the history and physical examination findings. As therapy, 56% of patients reported improvement, but the duration was short lived.
  
  
• Editorial Comment
  The authors describe their contemporary experience with cystoscopy and hydrodistention. They utilize a technique of filling for 2 minutes at 100 cm pressure and then draining and repeating the process. Their bleak long term results, in addition to the companion review in this issue on SNS, highlight the challenge of this disease. Many advocate the use of normal saline as the instillate when hydro distending the bladder to minimize potential complication if there should be a bladder disruption.

Dr. Steven P. Petrou
Associate Professor of Urology
Mayo Medical School
Jacksonville, Florida, USA