Bladder Wall Thickening in Computerized Tomography Might be Associated with the Bladder Centered Interstitial Cystitis/ Bladder Pain Syndrome

Chen, Wei-Hsin; Jhang, Jia-Fong; Ho, Han-Chen; Jiang, Yuan-Hong; Lee, Cheng-Ling; Hsu, Yung-Hsiang; Yu, Wan-Ru; Kuo, Hann-Chorng

Bladder Wall Thickening in Computerized Tomography Might be Associated with the Bladder Centered Interstitial Cystitis/ Bladder Pain Syndrome

Chen W¹, Jhang J¹, Ho H², Jiang Y¹, Lee C¹, Hsu Y³, Yu W⁴, Kuo H¹

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Links
	Abstract 154
	On Demand Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction Scientific Open Discussion Session 17
	On-Demand
	Painful Bladder Syndrome/Interstitial Cystitis (IC) Imaging Pathophysiology
	1. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan, 2. Department of Anatomy, Tzu Chi University, Hualien, Taiwan, 3. Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan, 4. Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
Presenter
W Wei-Hsin Chen
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Abstract

Hypothesis / aims of study

This study was designed to evaluate the clinical significance of bladder wall thickening in computerized tomography (CT) in patients with interstitial cystitis/ bladder pain syndrome (IC/BPS).

Study design, materials and methods

Patients with IC/BPS were prospectively enrolled and were classified into three groups: smooth bladder wall, focal bladder thickening, and diffuse bladder thickening. Urodynamic study was performed to rule out bladder outlet obstruction. All patients underwent cystoscopic hydrodistention, during which the maximal bladder capacity (MBC) and the grade of glomerulation hemorrhage were recorded. Bladder biopsy specimens were obtained and were analyzed by a single pathologist who was blinded to clinical data.

Results

Among the one hundred IC/BPS patients, 49 had smooth bladder wall, 36 had focal bladder thickening, and 15 had diffuse bladder thickening in CT scan. The proportion of diffuse and focal bladder thickening was higher in patients with Hunner’s lesion than those without (p<0.0001). Patients with diffuse bladder thickening had significantly higher ICSI scores, decreased first sensation of filling (FSF), decreased first sensation (FS), smaller cystometric bladder capacity (CBC), smaller maximal bladder capacity (MBC), and smaller voided volume. Patients with focal and diffuse bladder thickening had significantly higher grades of glomerulation after hydrodistention (p=0.006). In terms of pathophysiology, patients with focal and diffuse bladder thickening had a significantly higher proportion of inflammatory cell infiltration, uroepithelium cell denudation, and granulation tissue (p=0.045, 0.002, and 0.005, respectively). The proportion of ESSIC type C was higher in the IC/BPS patients with focal or diffuse bladder thickening than that in ESSIC type A (p=0.011).

Interpretation of results

Focal and diffuse bladder thickening is associated with the presence of Hunner’s lesion. Focal and diffuse bladder thickening is also associated with more severe IC/BPS symptoms (higher ICSI scores). Focal and diffuse bladder thickening is related to higher disease extent (higher grades of glomerulation after hydrodistention). Focal and diffuse bladder thickening is also related to changes in certain urodynamic parameters, including smaller cystometric bladder capacity, smaller maximal bladder capacity, smaller first sensation of filling, decreased first sensation, and smaller voided volume. Diffuse bladder thickening is related to certain histopathology findings of chronic inflammation, including uroepithelium cell denudation, inflammatory cell infiltration, granulation tissue formation.

Concluding message

The bladder wall thickening under computerized tomography is correlated to the clinical phenotypes of IC/BPS as well as the histopathology finding. Focal and diffuse bladder thickening might indicate chronic inflammation in the bladder wall and urothelium. Treatment focused on the thick bladder wall portion might effectively eradicate chronic inflammation and improve IC conditions.

Figure 1

Figure 1. Classification of bldder CT imaging (A) Smooth bladder wall, (B)(C)(D)(E) focal bladder thickening, (F) diffuse bladder thickening

Figure 2

Table 1. The patient demographics and the clinical data of the 100 patients with interstitial cystitis/bladder pain syndrome

References

Hanno PM, Erickson D, Moldwin R, Faraday MM, American Urological A. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193(5):1545-1553.
Jhang JF, Hsu YH, Jiang YH, Ho HC, Kuo HC. Clinical Relevance of Bladder Histopathological Findings and Their Impact on Treatment Outcomes among Patients with Interstitial Cystitis/Bladder Pain Syndrome: An Investigation of the European Society for the Study of Interstitial Cystitis Histopathological Classification. J Urol. 2021;205(1):226-235.
Kim HJ. Update on the Pathology and Diagnosis of Interstitial Cystitis/Bladder Pain Syndrome: A Review. Int Neurourol J. 2016;20(1):13-17.

Disclosures

Funding Funded by Buddhist Tzu Chi Medical Foundation and Tzu Chi University Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Ethics Committee (IRB: 105-25-B) Helsinki Yes Informed Consent Yes