Hypothesis / aims of study
Patient with Painful bladder syndrome (PBS)/ Primary bladder pain syndrome (PBPS) suffer from a series of manifestation. Though the advancement of new local instillation, they have a poor quality of life. Cystoscopy plays a role in these patients subclassification, urodynamics is sometimes performed to exclude other disease. In this study, patients with cystoscopic or biopsy findings of PBS have urodynamics before and after treatment by local sodium hyaluronate. The aim of the study is to document the urodynamic findings in patients with PBS and assess the improvement and change after hyaluronic acid instillation.
Study design, materials and methods
518 patients with PBS diagnosed by cystoscopy performed UDS before treatment and 1 month after 6 instilltions of sodium hyaluronate. with hydrodistension and instillation of local anaesthetic.
Results
Age ranges between 18 till 52 (mean 34+/- 2.8), 75% females, all presented with suprapubic pain, negative urine cultures, and free abdominopelvic ultrasonography. O’leary Questionnaire was filled by all patients, mean score 18 (sd 3, range 7-24) pre treatment, with mean of 16(sd 2, range 6-24) post treatment 72% of the patients had hunner lesions, whie the remaining 145 patients had only glomerulations.
Urodynamics pre-treatment shows a decreased functional capacity with a mean of 195 cc (10.8), exaggerated sensation with pain and suprapubic fullness starting at 76 cc (58-115cc), average compliance in 96% of the studied population, slight hypocompliance in remaining 21 patients. No detrusor overactivity was noted in any of the patients pre-treatment, while terminal detrusor overactivity was prevalent in 18 %. None of the patients managed to complete the voiding phase with the catheter inserted, mean Qmax was 17 ml/sec and insignificant residual urine was prevalent in 91% of the patients. 47 patient had residual urine equal to or more than 30% of the bladder capacity.
Urodynamics 3 months after treatment shows higher mean functional capacity 220 cc (12cc), exaggeratted sensation with fullness starting at 96 cc, persistent hypocompliance in 21 patients with mean EFP 25 cmH2O. ( 4 ). Terminal overactivity in 12%, mean Qmax 18 ml/sec (3 ), and perisistent elevation in the residual urine in 47 patients.
Interpretation of results
Patients with PBS will have symptomatic improvement persisitent up to 3 months post hyaluronic acid instillation, slight improvement in sensation and functional capacity in urodynamics. Meanwhile persistence of hypocompliance and elevated residual urine post-operative. None of the above parameters was statistically significant.