Symptom profile variability of interstitial cystitis/painful bladder syndrome by age

Abstract

Study Type--Diagnostic (symptom prevalence). Level of Evidence 2b. What's known on the subject? And what does the study add? Symptom variability is profound in the population of patients diagnosed with interstitial cystitis and painful bladder syndrome because these diagnoses represent a very heterogeneous patient population. Recently, younger patients are being diagnosed with these pain syndromes, without any specific investigation into the symptoms they experience. We identified that patients diagnosed with interstitial cystitis and painful bladder syndrome have variable clinical symptom profiles depending on the age at the time of their diagnosis. Dyspareunia, external genitalia pain, urgency, frequency and dysuria were more common in younger patients whereas nocturia, urinary incontinence and the presence of Hunner's ulcers were more common in older patients. Better defining symptom profiles for patients at the time of evaluation may potentially aid in more accurate and expedited diagnosis of these conditions, particularly in the youngest patient population which is being recognized more commonly in recent times.

Objective: • To investigate the clinical profile differences among patients with interstitial cystitis/painful bladder syndrome (IC/PBS) based upon age at the time of diagnosis from childhood into the geriatric age group.

Methods: • An analysis of 268 patients with IC/PBS seen between 1990 and 2008 was performed. • Three age cohorts were analysed: <30 years, ≥30 years but <60 years, and ≥60 years of age at time of diagnosis. • Patient demographics, disease characteristics and IC/PBS-associated symptoms were compared across the three groups.

Results: • Of the 268 patients, 60 were <30 years of age at the time of IC diagnosis (median 22, range 11-29), 105 were ≥30 but <60 years (median 48, range 30-59) and 103 patients were ≥60 years of age (median 69, range 60-88). • Of the patients in the youngest, middle and oldest age cohorts: 12.0, 42.0 and 39.8% had Hunner's ulcers, respectively (P<0.001). • Dyspareunia and external genitalia pain were more common in the youngest age cohort, P<0.001 and P=0.001, respectively. • Urinary urgency (P=0.033), frequency (P=0.006) and dysuria (P<0.001) were also more common in patients diagnosed before 30 years of age. • The reported rate of nocturia and urinary incontinence increased with age, P=0.002 and P<0.001, respectively.

Conclusions: • Patients with IC/PBS analysed across a wide spectrum of ages at time of diagnosis portrayed a unique symptom profile pattern. • Patients diagnosed at the youngest ages experienced significantly more urinary urgency, frequency, dysuria, dyspareunia and pain in their external genitalia. • Older patients had higher rates of nocturia, urinary incontinence and Hunner's ulcer disease.