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Sources of Funding: None

Introduction

It has been hypothesized that IC/BPS (Interstitial cystitis/bladder pain syndrome) patients with Hunner lesions inside the bladder represent a different phenotype than IC/BPS patients without Hunner lesions. Here we compared the urologic symptoms (urgency, frequency, nocturia, urologic pain, bladder hypersensitivity, sexual function) and non-urologic features (severity and distribution of systemic pain, co-morbid functional pain syndromes, anxiety, depression) between IC/BPS patients with and without Hunner lesions visible on regular cystoscopy without hydrodistention.

Methods

A battery of questionnaires were given to IC/BPS patients from our clinical practice to assess their urologic and non-urologic features (Interstitial Cystitis Symptom and Problem Indexes (ICSI, ICPI), Pelvic Pain and Urgency/Frequency (PFU) Questionnaire, numeric ratings of pain, urgency, frequency, RICE Questionnaire, AUA Symptom Index , Body Pain Map, Brief Pain Inventory (BPI), Poly-Symptomatic Poly-Syndromic Questionnaire (PSPS-Q), and history of co-morbid functional pain syndromes). Among them, 123 patients underwent cystoscopy.

Results

23% (28 patients) had classic Hunner lesions visible inside the bladder on regular cystoscopy without hydrodistention. 77% (95 patients) did not have Hunner lesions. When the two IC/BPS sub-groups were compared (with versus without Hunner lesions), IC/BPS patients with Hunner lesions were about a decade older (mean age 53±17 versus 42±15, p=0.002), more likely to report nocturia/night time frequency (p=0.016), and less likely to report anxiety (22% versus 43%, p=0.049) and irritable bowel syndrome (7% versus 34%, p=0.007) compared to IC/BPS patients without Hunner lesions. There was no statistical difference in their composite scores (ICSI, ICPI, PFU, AUASI), severity and bother of urologic pain, bladder hypersensitivity features (eg, increase in pain with bladder filling, decrease in pain with bladder emptying), daytime frequency, urgency, sexual function, severity and distribution of systemic pain, fibromyalgia, chronic fatigue syndrome, migraine headache, vulvodynia, and depression.

Conclusions

A significant percentage (23%) of IC/BPS patients demonstrate classic Hunner lesions inside the bladder during cystoscopy without hydrodistention. IC/BPS patients with Hunner lesions did not exhibit urologic and non-urologic features that would easily distinguish them from those without Hunner lesions. Cystoscopy is needed to identify these patients.

Funding

None