Identification of criteria for the effectiveness of treatment of women with bladder pain syndrome (BPS) according to specialized questionnaires, visual analogue pain scale (VAS) and voiding diaries

In our study took part 110 women with BPS. The average age was 53.1 ± 6.2 years, the duration of the disease was 30.4 ± 24.2 months. All patients got conservative drug treatment. The first line of therapy included behavioral and drug therapy. Behavioral therapy consisted in the use of a special diet when patients refused to use food and drink provoking an increase in the symptoms of the disease; exercises for pelvic muscles, including using the biofeedback method; bladder training. Drug therapy included the use of nonsteroidal anti-inflammatory and antihistamine drugs, alpha-blockers, antidepressants. Intravesical instillations performed for 10 days. The duration of first line therapy was 30 days.For 89 patients was performed bladder hydrodistension. The duration of hydrodistension was 3 minutes. Effective treatment was in 46 patients (51.7%), ineffective in 43 patients (48.3%).The third group of the patients were those who underwent intravesical injection ofbotulin toxin type A, there were 43 (48,3%) patients. Firstline (conservative drug treatment) and second line (bladder hydrodistension) of treatment were not effective to them. We were using standard approach, the injection was made in 20 points of the submucosal layer of the bladder (5 U). The total dose of botulinum toxin was not more than 100 U.The procedure was performed under general anesthesia. The effectiveness of the treatment was carried out 1 month after the procedure, based on the results of the survey. The 3rd line of treatment was effective in 95.3% of patients; in 2 patients, no significant effect was obtained.Evaluation of the patient's quality of life was carried out using the Pelvic Pain and urgency / frequency patient symptom score (PUF Scale) and O’Leary-Sant Symptom Index, VAS and voiding diaries, which were filled before the treatment, as well as after each stage of treatment. We used those questionnaires because the quality of life of patients reliably correlated with the sum of points according to the PUF Scale questionnaire (p = 0.0003); the score on the O’Leary-Sant SI questionnaire (p = 0.0002); VAS (p = 0.0008); frequency of urination (p = 0.005).

Quality of life of patients was reliably correlated with the sum of points according to the PUF Scale questionnaire (p = 0.0003); the score on the O’Leary-Sant SI questionnaire (p = 0.0002); VAS (p = 0.0008); frequency of urination (p = 0.005). The effectiveness of the first line of therapy was 19.1%, the effectiveness of thesecond line of therapy was 51.7% (total effectiveness of second lines of therapy was 60.9%), the effectiveness of the third line of therapy was 95.3% (total efficiency 98.2%).Conservative drug treatment was effective in 21 (19.1%) patients. Other 89 (80.9%) patients underwent bladder hydrodistension, which was effective in 46 (51.7%) patients. In 43 (48.3%) patients, it was not effective. Intravesical botulin therapy was performed in these patients, which was effective in 41 (95.3%) patients.

The results of the ROC analysis for the decisive regression functions revealed a change in the value of the indicators leading to a significant improvement in the quality of life of patients, which we took as criteria for treatment effectiveness (any of the following): a decrease in the amount of points according to the PUF Scale questionnaire by 20% or more; a decrease in VAS by 2 points or more; decrease in frequency of urination by 20% or more; a reduction in the amount of points on the O’Leary-Sant SI questionnaire by 20% or more.

Specialized questionnaires, VAS and voiding diary is important tool for diagnosing BPS. In our study it was shown that a decrease in the scores of the questionnaires, VAS and the frequency of urination to the indicated values suggests the effectiveness of the treatment line and the absence of the need for a subsequent line of treatment.