Hydrodistension under local anesthesia for patients with suspected painful bladder syndrome/interstitial cystitis: Safety, diagnostic potential and therapeutic efficacy

Objectives: To evaluate the safety, diagnostic potential and therapeutic efficacy of cystoscopy with hydrodistension under local anesthesia in patients with suspected painful bladder syndrome/interstitial cystitis (PBS/IC). Methods: Thirty-six patients with frequency, urgency or bladder pain for >= 6 months and an average voided volume of < 200 mL were enrolled in the study. Hydrodistension was carried out 10 min after instillation of 10 mL of 4% lidocaine. The instilled saline volume for hydrodistension was determined based on each patient's level of tolerance of urinary sensation and symptoms. Results: Overall, 30 patients (median age 54 years, range 25-76) were evaluated. The median instilled saline volume was 450 mL (250 to 580 mL). No patients were admitted to hospital due to adverse events associated with hydrodistension. Glomerulation was found in 23 patients and two had Hunner's ulcers. Therapeutic efficacy at one month after hydrodistension was shown in 21/30 patients (71%). A median efficacy period of 20 +/- 3.7 weeks was determined by Kaplan-Meier analysis. Factors with an independent influence on therapeutic efficacy of hydrodistension were not identified, but patients with an instilled volume greater than the median volume had significantly longer efficacy periods (P < 0.022). Conclusions: Cystoscopy with hydrodistension under local anesthesia provides a simple and safe method for differential diagnosis and has some therapeutic efficacy in patients with suspected PBS/IC.