COEXISTENCE OF BLADDER PAIN SYNDROMEAND ENDOMETRIOSIS IN WOMEN WITH CHRONIC PELVIC PAIN
A. S. ARUNKALAIVANAN, H. KAUR;
Gynaecology, Waikiki Private Hosp., Waikiki, Australia.
Introduction: If we definechronic pelvic pain (CPP) as pain originating from the pelvic region,pain present much of the past six months, and pain severe enough tocause functional disability and require medical/surgicalintervention, then CPP accounts for more than 40% of alllaparoscopies and 12-26% of hysterectomies . Reported prevalenceis up to 39% of women of reproductive age, which makes CPP relativelycommon, comparable to asthma and back pain. Although endometriosis isvery common, Bladder Pain Syndrome (BPS), which is emerging as a morecommon disorder than previously recognized, should also beconsidered. Missed diagnosis of BPS may result in unnecessaryhysterectomy. 80% of women reporting persistent pain or recurrentpelvic pain following hysterectomy for CPP were found to have pain ofbladder origin. . Due to the numerous possible causes, themanagement of CPP is challenging.
Objective: To estimatethe prevalence of coexistent BPS and endometriosis in women whopresented with chronic pelvic pain.
Methods: Thisprospective cohort study was conducted in 30 women who presented withthe CPP and the lower urinary tract symptoms (LUTS). Women whounderwent concomitant laparoscopy and cystoscopy between 2015 and2016 and met the symptom and procedure criteria were included. Thefollowing data were extracted at chart review: age at surgery;parity; race; preoperative symptoms of dysmenorrhea, dyspareunia, andurinary symptoms including overactive bladder symptoms, voidingdysfunction and dysuria; operative findings; procedures performed;and postoperative diagnoses. Both laparoscopy and cystoscopy withhydrodistension were done at the same sitting. Endometriosis wasdiagnosed and staged laparoscopically as per American Society forReproductive Medicine (ASRM) classification. Cystoscopy was carriedout using 12 degree cystoscope. Irrigation was allowed to flow undergravity (100 cm pressure), and hydrodistension was maintained for 2minutes, after which the bladder was drained. Bladder wall biopsieswere performed when glomerulations were noticed. The diagnosis of BPSwas determined based on preoperative symptoms (pelvic pain,overactive bladder symptoms, dysuria, and dyspareunia) andcystoscopic findings consistent with BPS: glomerulations, at least 10per quadrant in three or more quadrants. The data was analysed usingIBM-SPSS version 24.0 release.
Results: Table 1Demography
Table 2 Pre-Operative featuresand Post-Operative Diagnosis
29(96.6%) women were caucasian andone was asian. (Overall the prevalence of BPS is 27(90%) andendometriosis is 17(56.7%); both conditions were present in17(56.7%). Anterior vaginal wall tenderness and other fornicealtenderness were present in all 30 women. Glomerulations were presentin 27(90%) women. Bladder wall biopsy was done in 27(90%).Histological confirmation of IC  (based upon Mast cell count) waspresent in 20 (74.1%) out of 27 biopsies. Pain on filling bladder waspresent only in 11(36.7%) of cases. Vulvodynia coexisted in 6(20%)cases.
Conclusions: This study’s findings suggest thatBPS is more prevalent than endometriosis in this cohort of women withCPP and is an important etiological factor in CPP. Since there is asignificant overlap of symptoms such as dyspareunia and LUTS,clinicians should consider simultaneous evaluation of the bladder bycystoscopy and hydrodistension at the same sitting aslaparoscopy.
References: 1. Obstet Gynecol 95 (3):319-3262. Clin Obstet Gynecol 2007 50 (2):412-424.3. BJU Int 102(2):204-207; discussion 207.