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Histological evidence supports low anesthetic bladder capacity as a marker of a bladder-centric disease subtype in interstitial cystitis/bladder pain syndrome

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Abstract

Introduction and hypothesis

Low anesthetic bladder capacity has been shown to be a biomarker for bladder-centric interstitial cystitis/bladder pain syndrome (IC/BPS). The goal of this study was to determine if histopathological evidence from bladder biopsies supports anesthetic bladder capacity (BC) as a marker to distinguish a bladder-centric IC/BPS subtype.

Methods

From a review of our large IC/BPS cohort of patients undergoing hydrodistention, we identified a total of 41 patients with low BC (≤ 400 ml); an additional 41 consecutive patients with BC > 400 ml were selected as the comparator group. The original bladder mucosal biopsy pathology slides were re-reviewed by a single pathologist (blinded to patient information) using a standardized grading scale developed for this study.

Results

Histologically, the low BC subjects exhibited higher levels of acute inflammation (p = 0.0299), chronic inflammation (p = 0.0139), and erosion on microscopy (p = 0.0155); however, there was no significant difference in mast cell count between groups (p = 0.4431). There was no significant gender difference between the groups; female patients were the majority in both groups (low BC: 94.12%, non-low BC: 100%; p = 0.1246). Individuals in the low BC group were older (p < 0.0001), had a higher incidence of Hunner’s lesions on cystoscopy (p < 0.0001), and had significantly higher scores, i.e., more bother symptoms, on two IC/BPS questionnaires (ICPI, p = 0.0154; ICSI, p = 0.0005).

Conclusions

IC/BPS patients with low anesthetic bladder capacity have histological evidence of significantly more acute and chronic inflammation compared with patients with a non-low bladder capacity. These data provide additional evidence to support low bladder capacity as a marker of a distinct bladder-centric IC/BPS phenotype.

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Acknowledgements

The authors thank the study participants. Funding for this study was provided, in part, by the Interstitial Cystitis Association (2014 Pilot Research Program Grant Award; SJW) and the NIDDK (R21DK106554-01; SJW).

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Authors and Affiliations

  1. Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, 391 Technology Way, Winston Salem, NC, 27101, USA

    Jeffrey S. Schachar, Robert J. Evans, Joao Zambon, Gopal Badlani & Stephen J. Walker

  2. Department of Pathology, Wake Forest Baptist Medical Center, 391 Technology Way, Winston Salem, NC, 27101, USA

    Graham E. Parks

  3. Wake Forest Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, 391 Technology Way, Winston Salem, NC, 27101, USA

    Stephen J. Walker

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  1. Jeffrey S. Schachar
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  2. Robert J. Evans
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  3. Graham E. Parks
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  4. Joao Zambon
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  5. Gopal Badlani
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  6. Stephen J. Walker
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Correspondence to Stephen J. Walker.

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Schachar, J.S., Evans, R.J., Parks, G.E. et al. Histological evidence supports low anesthetic bladder capacity as a marker of a bladder-centric disease subtype in interstitial cystitis/bladder pain syndrome. Int Urogynecol J 30, 1863–1870 (2019). https://doi.org/10.1007/s00192-019-04038-0

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  • DOI: https://doi.org/10.1007/s00192-019-04038-0

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