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abstract

118 - OVERACTIVE BLADDER AND BLADDER PAIN SYNDROME; PAIN OF THE SAME SPECTRUM?

118

OVERACTIVE BLADDER AND BLADDER PAINSYNDROME; PAIN OF THE SAME SPECTRUM?

A. A. FORD1, R. BRAY2, V. ASFOUR 3, R. FERNANDO 4, A.DIGESU 5, V. KHULLAR 6;
1St.Marys Hosp., London, United Kingdom, 2St Marys Hosp.,london, United Kingdom, 3Imperial Hlth.care trust, London,United Kingdom, 4Imperial Coll. Hlth.care NHS Trust,London, United Kingdom, 5Imperial Coll. NHS Trust, London,United Kingdom, 6Imperial Coll. London, London, UnitedKingdom.

Introduction: The overactivebladder (OAB) symptom syndrome is defined as ‘urgency with orwithout urgency incontinence, usually with frequency and nocturia’.Bladder pain syndrome (BPS) is defined by the European Society forthe Study of Interstitial Cystitis/Bladder Pain as “pelvic pain,pressure or discomfort perceived to be related to the bladder,lasting for at least 6 months, and accompanied by at least one otherurinary symptom”. Whilst in BPS the hallmark symptom is pain onbladder filling and in OAB urgency is the predominant symptom, therecould be a cross-over between symptoms of OAB and BPS. Urgency iscommonly reported in both conditions but studies have shown that theurgency experienced by those patients with BPS differs from thatexperienced by those with OAB. In BPS there is an inflammatorycomponent with evidence of increased cytokines and interleukins. MostOAB is idiopathic but urothelial dysfunction, abnormal expression ofsensory receptors, dysfunction of suburothelial interstitial cells,and increased excitability of detrusor muscle have all been proposed.Several researchers have linked OAB and BPS separately to chronicbladder inflammation with studies showing low-grade bladderinfections or increased levels of mast cells in the bladder wall.Bladder and urinary nerve growth factor and serum C-reactive proteinare also increased in patients with both OAB and BPS. In the clinicalsetting patients presenting OAB or BPS often pose a great challengewhen trying to achieve symptom resolution and treatment success.Patients with OAB have poor compliance with anticholinergicmedication and a major contributing factor to this is lack oftreatment effect. By comparison, patients with BPS have littleresponse to the wide variety of treatment options available. Giventhere appears to be overlap in symptomatology, pathology and bothconditions have yet to achieve widespread treatment success, can oneconsider the possibility that OAB and BPS are opposing ends of thesame clinical spectrum?
Objective: We hypothesise that OABand BPS have shared clinical presentation and when performingcystoscopic and histological examination that these investigationsshow a spectrum of disease.
Methods: In a retrospectiveobservational study we included women who underwent diagnosticcystoscopy and bladder biopsy between August 2014 and August 2016 ina single centre study. All patients completed the Kings HealthQuestionnaire. We correlated their symptoms (using ICS terminology)to cystoscopic findings and histology results. Data was analysed andstatistical testing performed using SPSS.
Results: Weanalysed 161 women with a mean age of 48.9 years. 68% were Caucasianand 32% comprised women from other groups. 102/161 (64%) womenreported bladder pain in conjunction with symptoms of overactivebladder. At the time of cystoscopy all women reporting OAB andbladder pain showed evidence of inflammation (squamous metaplasia,bullous odema, increased vascularity, and refill haemorrhages). 12/94(13%) women showed histological evidence of infective cystitis, and79/94 (84%) women showed evidence of chronic inflammation with only3/94 (3%) showing normal histology. In comparison, 59 womenundergoing cystoscopic assessment had symptoms of OAB with nocomplaint of bladder pain or history of recurrent urinary tractinfection. When correlated to cystoscopic findings all women showedone or more signs of inflammation at the time of cystoscopy.Histological assessment found 2/51 (4%) women had evidence ofinfection, and 47/51(92%) women showed evidence of chronicinflammation on bladder biopsy and only 2/51 (4%) women had normalhistology. Comparing patients with OAB symptoms with and withoutbladder pain, a chi square test was performed to ascertain whethersymptoms can predict diagnosis and histological outcome. Urgency andurgency urinary incontinence are the only symptoms whichstatistically significantly reliably predicted theseoutcomes.
Conclusions: This early report seems to indicatethe possibility of a relationship between the aetiology of OAB andBPS. Of the two groups of women (women with and without symptomaticbladder pain) the two groups have similar cystoscopic andhistological findings. If we consider the potential of aninflammatory component and spectrum of disease between OAB and BPSthis could provide explanation as to why overactive bladdertreatments and treatments for bladder pain are not effective in asignificant percentage of patients.
References:

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Neurourol 2010;29 (1): 4-20