Currently, there is no effective and durable treatment for all patients with interstitial cystitis/ bladder pain syndrome (IC/BPS). It is possible that multiple pathophysiology underlying this disease. This study investigated the association between clinical parameters and urine biomarkers and overall treatment outcome in women with IC/BPS.

Women with IC/BPS were retrospectively included in this study. The clinical symptoms, videourodynamic study, cystoscopic features under anesthesia, and urinary inflammatory and oxidative stress biomarkers were investigated and compared between patients who were satisfactory or unsatisfactory to different bladder therapy for IC/BPS. The clinical parameters were searched for predicting a satisfactory treatment outcome.

A total of 315 IC/BPS patients including 291 non-Hunner’s IC (NHIC) and 24 Hunner’s IC were included, with a mean age of 53.3 ± 13.3 years. With a median follow-up period of 10 years, among the NHIC patients, 167 (57.4%) patients had a satisfactory outcome (GRA 2 or 3) after treatment, the remaining 124 (42.6%) had a unsatisfactory outcome. The clinical characteristics, cystoscopic features, and urodynamic parameters between NHIC patients with and without satisfactory outcome are shown in Table 1. Among four subgroups after cystoscopic hydrodistention, patients with MBC > 760ml with grade 0 or 1 and MBC > 760ml with grade 2 or 3 glomerulation had higher satisfactory outcome (68.2% and 65.1%, respectively). In addition, patients with a lower VAS pain score, higher Qmax, FSF, voided volume, and CBC all had higher rate of satisfactory outcome. Multivariate logistic regression analysis revealed that the larger MBC in hydrodistention (odd ratio 1.002, 95% CI 1.001-1.004, p = 0.007) and larger FSF in VUDS (odd ratio 1.007, 95% CI 1.001-1.013, p = 0.020) predict a satisfactory outcome after different bladder therapy. (Table 2)
The urinary levels of lower C-X-C motif chemokine ligand 10 (CXCL10), 8-hydroxydeoxyguanosine (8-OHdG), and 8-isoprostane also predict a satisfactory treatment outcome in patients with NHIC.

The results of this study reveal that NHIC patients with a larger FSF and MBC, and lower grade of bladder inflammation as shown by lower levels of urine inflammatory proteins will have a higher satisfactory treatment outcome than those with small bladder capacity and higher grade of bladder inflammation. Using larger FSF or MBC, and lower levels of urine biomarkers CXCL 10, 8-OHdG, and 8-isoprostane, we can predict patients with NHIC might have a higher rate of overall satisfactory outcome after bladder treatment, indicating lower grade of bladder inflammation.
Patients with a larger FSF in videourodynamic study or a higher MBC after cystoscopic hydrodistention under anesthesia had a satisfactory treatment outcome. Among the urine biomarkers, lower urinary levels of CXCL 10, 8-OHdG, and 8-isoprostane provide predictive value for a satisfactory outcome after bladder therapy. These predictive parameters reflect less bladder inflammation, the better treatment outcome for patients with NHIC. For patients with NHIC, we might use these clinical and urinary parameters to predict treatment outcome.

The results of this study revealed that NHIC patients with larger FSF and MBC, and lower urinary levels of CXCL10, 8-OHdG, and 8-isoprostane might have a satisfactory outcome, indicating less bladder inflammation may lead to a better treatment result.

Jhang JF, Jiang YH, Kuo HC. Current Understanding of the Pathophysiology and Novel Treatments of Interstitial Cystitis/Bladder Pain Syndrome. Biomedicines. 2022;10:2380.
Yu WR, Jiang YH, Jhang JF, Kuo HC. Use of Urinary Cytokine and Chemokine Levels for Identifying Bladder Conditions and Predicting Treatment Outcomes in Patients with Interstitial Cystitis/Bladder Pain Syndrome. Biomedicines. 2022 May 17;10(5):1149.
Jhang JF, Jiang YH, Hsu YH, Ho HC, Kuo HC. Decreased urothelial cytoskeleton and cell proliferation protein expression suggest interstitial cystitis/bladder pain syndrome patients with Hunner's lesion and grade 3 glomerulation might be different from other types of patients. Int J Urol. 2021 Aug;28(8):823-830.