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Symptoms Of BPS/IC May Complicate Treatment Algorithm Of Patients Presenting With Other Urogynecologic Disorders

June 17, 2017

UroToday - Exclusive reliance on symptom-based diagnosis has increased the prevalence of BPS/IC significantly. Charles Butrick and colleagues in Overland Park, Kansas have retrospectively reviewed a cohort of 408 patients with BPS/IC in an effort to characterize a cohort of patients who presented to a referral urogynecologic center with complaints of various pain and urogynecologic pelvic floor disorders and who, after an initial evaluation were felt to have symptoms that would suggest BPS/IC. The clinical diagnosis was based on a history of pelvic or bladder pain that worsened with bladder filling and typically was associated with a history of frequency or a functional bladder volume of less than 4 ounces. Throughout the paper there seems to be use of both the terms BPS/IC and PBS/IC with no clear distinction. Many interesting conclusions are reported.

The average age of this cohort of patients was 48.3 + 16.1 years. One hundred fifty-seven of patients had a chief complaint of bladder pain and 98 complained of chronic pelvic pain. Hypertonic pelvic floor dysfunction was identified in 70.4% of patients with 80% demonstrating an abnormal uroflow. Parson's potassium sensitivity test was positive in 83% of these patients. Seventy-seven per cent of the 120 patients who failed to show benefit from therapeutic anesthetic cocktail instillation nevertheless had a positive potassium test. It is not clear to this reader what benefit the potassium test had in terms of diagnostic or treatment algorithm in this study.

Ninety-seven per cent of patients were given more than one diagnosis, with "PBS/IC" in 79% and myofascial pain in 50% and pelvic floor hypertonic dysfunction in 26%. Patients were divided into 4 subgroups: BPS/IC (157), chronic pelvic pain (98), vulvodynia/dyspareunia (54%), and "other" (113). The potassium sensitivity test and the Pain, Urgency, Frequency (PUF) score did not discriminate among subgroups. The authors note that 5-10% of patients with chief complaints of stress or urge incontinence or prolapse were also found to have BPS/IC. As surgery can induce and/or flare pre-existing pain disorders, the authors identify these patients and treat their bladder pain disorders prior to treating any non-pain disorder, especially if that treatment requires surgery.

The authors also observed that their cohort of patients demonstrated a history of childhood bladder disorders as suggested by a history of nocturnal enuresis past the age of 6, recurrent bladder infections, and urethral dilatations in childhood in 16%. The prevalence of these disorders is typically thought to be in the range of 7% in the normal population.

Butrick CW, Sanford D, Hou Q, Mahnken JD
Int Urogynecol J Pelvic Floor Dysfunct. 2009 May 21. Epub ahead of print

UroToday Contributing Editor Philip M. Hanno, MD, MPH

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