Prolonged hydrodistention of the bladder for symptomatic treatment of interstitial cystitis:: Efficacy at 6 months and 1 year

Objective: To determine the efficacy of hydrodistention of the bladder for symptomatic treatment of interstitial cystitis after 6 months and 1 year of follow-up and to identify a predictive factor. Methods: The study included 65 consecutive patients (a first retrospective series of 33 and a second prospective series of 32) treated by hydrodistention of the bladder for urinary symptoms attributed to interstitial cystitis. All experienced pain on bladder filling, which was relieved by micturition or bladder voiding, and had more than two nocturias. Glomerulations were detected at short hydrodistention during cystoscopy. No patients were subject to NIH exclusion criteria. Hydrodistention was performed continuously for 3 h without rest intervals under epidural anesthesia using a balloon with a pressure equal to the patient's mean arterial pressure. Efficacy was defined as the disappearance of pain on bladder filling or the persistence of moderate, non-disabling pain for which the patient did not request treatment, and a low frequency of nocturia (zero to two times). The efficacy period was estimated according to Kaplan-Meier methods for survival curves. The second series was used to verify the analytic results of the first series. Results: Treatment efficacy was 12/32 (37.7% CI: 20.7-54.3) at 6 months and 7/32 (21.9% Cl: 7.6-36.2) at I year for the first series, and 18/30 (60.0% Cl: 45.0-75.0) at 6 months and 13/30 (43.3% Cl: 25.6-61.1) at I year for the second series. In both series, results were better for the subgroup of patients with a bladder capacity ! 150 ml during cystometry before distention. Conclusions: This study showed good but transient efficacy in the least developed or least severe forms of the disease. (C) 2002 Elsevier Science B.V All rights reserved.