Background:
Painful Bladder Syndrome /Interstitial cystitis (PBS/IC) is often accompanied by obstructive symptoms such as slow stream, dribbling, straining to void, and incomplete emptying. With recently published pressure flow cutoff values for female bladder outlet obstruction (1) we decided to evaluate this population for the possibility of Bladder Outlet Obstruction (BOO).
Methods:
This is a retrospective chart review of a total of 274 female patients all diagnosed with PBS/IC based on the Interstitial Cystitis Data Base Study Entry Requirements (2) and cystoscopy. Charts were reviewed for Lower Urinary Tract Symptom (LUTS) severity (0-3), severity of PBS/IC on cystoscopy (3), and UDPF studies. Forty-three patients were excluded. UDPF study was done in semi-sitting position with #7 F urodynamic catheters. The cutoff values of Maximum Flow Rate (Qmax) ≤12 ml/sec and Detrusor Pressure at Maximum Flow (PdetQmax) ≥25 cm H₂0 were used to define BOO in these women (1). Cystoscopy was done under general anesthetic. Bladder was dilated by filling water at 80 cm H₂0 for a minute. Statistical analysis was done using GraphPad Prism software. For group comparison t-test (unpaired) and contingency tables were used. P value of less than 0.05 was considered statistically significant at 95% confidence interval.
Results:
There were 231 women with a mean age of 52 who were included in the study. 193 patients presented with non-classical PBS/IC and 38 with classical PBS/IC. There were no significant differences in clinical symptoms of frequency, urgency, nocturia, suprapubic pain when comparing severity of PBS/IC. There was a slightly higher incidence of urge incontinence with classic PBS/IC (P=0.04). Maximum Cystometric Capacity (MCC) and detrusor overactivity on UDPF studies was statistically the same in classic and non classic PBS/IC. Mean residual urine was 77 ml in non classic and 56 ml in classic disease (p=0.0002). Total of 48% women met urodynamic criteria for bladder outlet obstruction, 46% women with non-classic PBS/IC and 55% with classic, but the difference between these two groups did not reach statistical significance (p=0.65). Women with classical PBS/IC had Qmax of 8.8 ml/sec and PdetQmax of 37.4 cm H2O and with non-classic PBS/IC Qmax 10.9 ml/sec and PdetQmax 33.3 cm H2O. The only statistical difference was in PdetQmax (0.002)
Conclusions:
Approximately half of the women with PBS/IC have urodynamic evidence of bladder outlet obstruction.

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