ASSOCIATIONS AMONG CYSTOSCOPIC AND URODYNAMIC FINDINGS FOR WOMEN ENROLLED IN THE INTERSTITIAL CYSTITIS DATA-BASE (ICDB) STUDY

Objectives. Interstitial cystitis is a symptom complex characterized b y pelvic pain, urinary urgency, urinary frequency, and nocturia. Patie nts with these symptoms, at the 5 clinical centers participating in th e National Interstitial Cystitis Data Base (ICDB) Study, have been eva luated with history and physical exams, questionnaires, and urodynamic studies. Methods. Of the 388 female subjects entered in the study as of December 31, 1995, 150 women have undergone cystoscopy with hydrodi stension. The data from the endoscopic procedures and the urodynamic s tudies were analyzed. The associations among cystoscopic and urodynami c findings were reviewed. Results. Patient demographics of this subgro up show a predominance of Caucasians 139/150 (92.7%), with the average age being 43 (+/-13.2) years. Of the total, 17 patients (11.3%) had a Hunner's patch (HP). The prevalence by center varied from a low of 2/ 38 (5.3%) to a high of 3/9 (33.3%). Bloody effluent following hydrodis tension was present in 113/150 (75.3%). Glomerulations appeared in var ying degrees (mild, moderate, severe) in 91.3% of the 150 patients. Th ere was a strong inverse relationship (P <0.001) between bladder capac ity under anesthesia and the presence of a HP (mean of 845 cc with HP absent versus a mean of 531 cc when present). The incidence of HP vari ed from 67.6% among women with a bladder capacity at hydrodistension o f <400 cc to 3.8% for those with a bladder capacity of at least 800 cc . The presence and increasing severity of glomerulations was positivel y associated (P <0.003) with the presence of HP, ranging from 0/13 (0% ) when glomerulations were not present to 6/31 (19.4%) when glomerulat ions were graded as severe. Of the patients with HP, 17/17 (100%) had glomerulations after hydrodistension. HP is more closely associated wi th the moderate to severe range of glomerulations (P <0.01). Nearly ha lf of the patients with HP or 8/17 (47.1%) had ''moderate'' glomerulat ions, while 6/17 (35.3%) had ''severe'' glomerulations. The volume at first sensation to void on urodynamics (mean 87 cc without HP versus 3 4.7 cc with HP) was highly inversely associated (P=0.002) with the pre sence of HP, but not with any of the other cystoscopic findings. Of pa tients with HP, 94% had a volume at first sensation to void of less th an or equal to 50 cc where only 36% of patients without HP had a volum e at first sensation to void of less than or equal to 50 cc. The volum e at maximum capacity on urodynamics was positively associated with th e volume at hydrodistension (P <0.001). Conclusions. Overall, patients with HP had lower bladder capacities, lower volumes at first sensatio n to void, and more severe glomerulations. Thus, the presence of HP wo uld imply a more severe case of interstitial cystitis. Logically, a hi gher bladder capacity on cystometrogram is associated with a higher vo lume at the time of hydrodistension, and bloody effluent is associated with more severe glomerulations. (C) 1997 by Elsevier Science Inc.