Do the National Institute of Diabetes and Digestive and Kidney Diseases cystoscopic criteria associate with other clinical and objective features of interstitial cystitis?

Abstract

Purpose: We compared urine markers, bladder biopsy findings and clinical features of patients with symptoms of interstitial cystitis (IC) who did or did not meet the cystoscopic criteria defined by the National Institute of Diabetes and Digestive and Kidney Diseases.

Materials and methods: Urine markers and symptom questionnaires were measured before and 1 month after bladder distention for IC. Bladder biopsies were taken at the time of distention. At distention patients were defined as meeting or not meeting the National Institute of Diabetes and Digestive and Kidney Diseases established cystoscopic criteria for IC. The 2 patient groups were compared.

Results: Urine marker levels were similar for the 2 groups, including antiproliferative factor, epidermal growth factor, heparin binding epidermal growth factor-like growth factor, cyclic guanosine monophosphate, interleukins 6 and 8, and methylhistamine. Bladder biopsy features were similar for the 2 groups. Bladder capacity with the patients under anesthesia was higher in those who did not meet the criteria (median 750 vs 1,000 ml, p = 0.005). Median age at symptom onset was 26 years in both groups. On the University of Wisconsin symptom scale patients who met the criteria had higher scores for daytime frequency (p = 0.002) and nocturia (p = 0.01). Symptom characteristics and symptom response after bladder distention were similar for the 2 groups.

Conclusions: Patients who met the cystoscopic criteria had worse daytime frequency and nocturia, and lower bladder capacity under anesthesia. However, the 2 groups had similar urine markers and bladder biopsy findings. The cystoscopic criteria do not appear to identify a distinct pathophysiological subset of patients with IC symptoms.