Correlates of Positive Response to Therapeutic Hydrodistension in Interstitial Cystitis/Bladder Pain Syndrome.

AIMS: The objective of this study was to assess the duration and clinical correlates of positive response in interstitial cystitis/bladder pain syndrome patients undergoing therapeutic bladder hydrodistension (HOD) or HOD with electrofulguration (for those with Hunner lesions).

METHODS

One hundred and twenty four women were enrolled in this prospective IRB-approved study. Participants answered a set of validated questionnaires at intake including chronic overlapping pain conditions (COPCs), brief pain index (BPI), and IC/BPS symptomatic questionnaires. These were repeated at 1, 2-, 3-, 6-, and 12-months posttreatment, together with a global response assessment (GRA). The primary outcome measure was the GRA score. A secondary analysis of patients who were strong responders to treatment was used to identify clinical correlates of positive response.

RESULTS

At 1-month post-HOD, 62 patients (53.9%) were responders (i.e., reported persistent positive response to treatment). Further, 21/49 (42.9%) respondents continued to report a positive response at 12 months. Logistic regression analyses identified several correlates of strong response to therapy including absence of Huynner lesions (odds ratio (OR) = 3.629), lack of diagnosis of fibromyalgia (OR = 0.31), lower number of total sites of pain on BPI pain map (OR = 0.91), fewer total number of COPCs (OR = 0.36), and lower complex medical symptom inventory scale (CMSI; OR = 0.91). After false discovery rate correction, only the CMSI remained statistically significant.

CONCLUSIONS

Therapeutic hydrodistension results in a clinically meaningful and sustained improvement in associated symptoms and pain for many patients. However, having higher scores on markers of a widespread pain/non-bladder centric phenotype was associated with a lower treatment success rate.