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Bladder Outlet Obstruction In Painful Bladder Syndrome/Interstitial Cystitis

August 16, 2017

UroToday - Obstructive symptoms such as slow stream, dribbling and straining are often reported by BPS/IC patients. Anne Cameron and Jerzy Gajewski from Michigan and Nova Scotia reported results of a retrospective chart review of 231 women diagnosed with this syndrome who met NIDDK research definition requirements (apart from exclusion for urodynamics evidence of detrusor instability). All had urodynamics. One hundred ninety-three had non-ulcer disease and 16.5% had ulcerative BPS/IC. Bladder outlet obstruction was defined as a maximum flow rate of 25cm H2O. Urinary tract symptom severity was compared between the ulcer and non-ulcer cystoscopic appearance of BPS/IC and between those with outlet obstruction on pressure flow urodynamics and those without.

Surprisingly, on the individual urinary symptom questions, the ulcerative and nonulcerative groups were not different with respect to reported urinary frequency, urgency, nocturia, or suprapubic pain. Of the 231 women, 48.1% were found to have urodynamics obstruction. 46.6% of these women had non-ulcer disease and the percent with and without ulcer was not statistically significant with regard to relation to obstruction.

The authors go on to note that they believe the obstruction found in almost half of the BPS/IC population studied is due to dysfunctional voiding (pelvic floor dysfunction?) and not stricture disease or other anatomical obstruction. This is based on results of endoscopy, ease of catheterization, and no difference between groups in history of incontinence surgery. The women with ulcerative disease did have small maximum cystometric capacities and slower peak flows when compared to those with the nonulcer variety. Pain associated with BPS/IC can make relaxation of the pelvic floor during voiding more difficult.

Cameron and Gajewski conclude by agreeing with current world opinion that urodynamics investigation of women with BPS/IC should not be recommended as a routine test, since most are treated clinically with little added information from the urodynamics.

Cameron AP, Gajewski JB
Neurourol Urodyn. 2009 Mar 19. Epub ahead of print.
doi:10.1002/nau.20729

UroToday Contributing Editor Philip M. Hanno, MD, MPH

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