Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease requiring long-term repeated treatment. Our recent study has found high prevalence of bladder and bladder outlet dysfunction (BOD) in female IC/BPS by videourodynamic study (VUDS) [1]. However, little was known about the VUDS findings in male IC/BPS patients. We investigated the baseline VUDS diagnoses and determined if the baseline VUDS findings can predict the long-term treatment outcome in male patients with IC/BPS.

Male IC/BPS patients with complete data of a symptom assessment, VUDS, potassium sensitivity test (PST) and cystoscopic hydrodistention were reviewed retrospectively. Men with VUDS evidence of benign prostatic obstruction were excluded. Those who have history of IC/BPS for more than 5 years were selected and contacted via telephone by a trained assistant. O'leary-Sant Symptom and Problem Index (ICSI, ICPI), pain visual analog scale (VAS) and overall treatment outcome (defined as score -1: worse, 0: 0-25% improvement, 1: 25-50%, 2: >50%, 3: symptom free) were acquired. The treatment modalities offered included pentosan polysulfate, hyaluronic acid, hydrodistention, onabotulinumtoxinA injection, electrocautery and platelet rich plasma instillation. The baseline clinical and VUDS parameters and diagnoses were analyzed and compared between patients with and without a successful treatment outcome (defined as a score≧2).

A total of 48 out of 66 male IC/BPS patients (mean age, 56.5± 12.9) were successfully contacted and enrolled in this study. Among them, 3 (6.3%) had ulcer type IC/BPS. Bladder dysfunction included hypersensitive bladder (HSB) in 37(77.1%) and detrusor overactivity (DO) in 7 (14.6%) patients. Bladder outlet dysfunction (BOD) included bladder neck dysfunction (BND) in 6 (12.5%), poor relaxation of external sphincter (PRES) in 20 (41.7%) and dysfunctional voiding (DV) in 1(2.1%). 46 (95.8%) men had underwent 2 or more (mean 3.0, range 2-5) treatment methods. The mean duration of history of IC/BPS was 16.3±9.67(5-46) years. The mean ICSI, ICPI and VAS improved significantly (all p=0.000) (Table 1) after long-term treatment. A successful treatment outcome could be achieved in 19 (39.6%) patients (Table 2). The mean baseline postvoid residual urine was significantly smaller in patients with a successful outcome than those without (Table 3). Nevertheless, there was no significant difference in other clinical or VUDS parameters or diagnoses between the two groups.

Our study demonstrated the high prevalence of HSB and BOD presented in male patients with IC/BPS according to the findings of VUDS. In addition, long-term treatment with multiple modalities may provide a considerable successful rate (39.6%) and even symptom free status (8.3%) for male IC/BPS patients. Patients with a smaller baseline PVR, which may represent a relatively good voiding function in IC/BPS, are more likely to achieve a successful treatment outcome. Moreover, since we have already corrected the bladder or bladder outlet dysfunction by medication after urodynamic study, the difference of long-term treatment outcome might not be remarkable between patients with different VUDS diagnoses.

HSB and BOD are common findings of VUDS performed in male IC/BPS patients. The ICSI, ICPI and VAS scores improved after long term treatment with multiple modalities with an overall successful rate of 39.6%. Male patients with a smaller baseline PVR are more likely to be treated successfully.

Kuo YC, Kuo HC. Videourodynamic characteristics of interstitial cystitis/bladder pain syndrome-The role of bladder outlet dysfunction in the pathophysiology. Neurourol Urodyn 2018 Mar 5. doi: 10.1002/nau.23542.