Login to Access Video or Poster Abstract: MP31-19
Sources of Funding: none

Introduction

While bladder hypersensitivity syndromes (BHS), such as overactive bladder (OAB) and interstitial cystitis/painful bladder syndrome (IC/PBS), classically exhibit the predominant symptoms of urgency and bladder pain, respectively, there is considerable symptom overlap between the conditions. Given this finding, we sought to define the fundamental features of each syndrome and refine diagnostic criteria through retrospective comparison of self-reported symptoms in female patients with a range of clinical presentations and symptom severities.

Methods

We performed univariate analysis comparing responses to the Genitourinary Pain Index (GUPI), OAB Questionnaire (OABq) and O’Leary-Sant Indices (ICSI/ICPI) between 26 asymptomatic, 42 IC/PBS, and 27 OAB patients. Only five specific questions differed significantly between the IC/PBS and OAB groups, which assessed either urgency incontinence or bladder pain with filling. We used these questions to generate a novel composite scoring system with urgency incontinence (UI) and bladder pain (BP) domains to differentiate these populations.

Results

While all validated questionnaires could distinguish between controls and BHS, no composite symptom scores differed significantly between the IC/PBS and OAB patients (Figure 1A). Only the GUPI Pain Domain was significantly different between OAB and IC/PBS patients, but was not useful for diagnostic evaluation, resulting in a Positive Predictive Value (PPV) of only 56-60% for a range of cutoffs. Our composite score gave a PPV of 100% and Negative Predictive Value (NPV) of 85% for a diagnosis of IC/PBS, as well as a PPV of 90% and NPV of 53% for a diagnosis of OAB (Figure 1B). These results are reflective of the prevalence of significant bladder pain (35%) in OAB patients and the presence of incontinence in IC/PBS patients.

Conclusions

The significant overlap of urinary tract symptoms between OAB and IC/PBS suggests common pathological elements. Future studies aimed at assessing the diagnostic value of novel classification schemes that address symptoms rather than specific diagnoses may improve patient prognosis. Regardless, these data suggest a new paradigm for how we approach BHS.

Funding

none