Repeated hydrodistention as therapy for interstitial cystitis has a low complication rate and does not decrease bladder capacity over time.
Boston-Repeated hydrodistention as therapy for interstitial cystitis (IC) has a low complication rate and does not decrease bladder capacity over time.
The procedure is also associated with symptomatic improvement, according to a retrospective review of patients who underwent two or more hydrodistentions at a single institution. The study was presented at the AUA annual meeting in Boston.
The use of cystoscopy and hydrodistention varies widely between providers, and the effect on symptoms is not clear from the literature, said first author Peter Kirk, a fourth-year medical student at the University of Michigan, Ann Arbor. The long-term effects are also not well understood. Working with Anne Pelletier Cameron, MD, and colleagues, his group measured changes in bladder capacity, development of ulcers, complications, and changes in symptoms of all patients undergoing hydrodistention for nonulcerative IC between 2006 and 2016 at the University of Michigan.
“We wanted to know if repeatedly stretching the bladder leads to scarring of the tissue and decreased bladder capacity over time, or if you follow these people over time, do you see people switching from nonulcerative IC to ulcerative IC,” he said. “Part of our analysis is driven by the fact that there’s not a lot of literature that rigorously assesses how patients respond to it.”
In its 2011 guideline, the AUA states that “Short-duration low-pressure hydrodistention may be undertaken if first- and second-line treatments have not provided acceptable symptom control.”
Ninety-seven patients (98% female) underwent multiple cystoscopy and hydrodistention for nonulcerative IC over the 10-year period. Some 63% had comorbid pain disorders. Their mean age was 35.7 years and mean body mass index was 27.1 kg/m2. Patients had as many as 18 hydrodistentions, with the median number being three. The median time between distentions was 245 days.
Treatments for IC included anticholinergics in 39%, tricyclic antidepressants in 37%, gabapentin/pregabalin in 20%, pentosane polysulfate (Elmiron) in 33%, phenazopyridine (Pyridium) in 39%, hydroxyzine in 11%, intravesical instillation in 38%, and an implanted neurostimulator in 6%.
“We didn’t see any significant changes in bladder capacity over time. We saw a really low complication rate and a really low 30-day readmission rate,” Kirk said. “We also saw only a single patient in our cohort develop new ulceration that wasn’t seen at their initial cystoscopy and hydrodistention.”
The complication rate with hydrodistention was <1%. The rate of 30-day readmission was 2%. The mean initial anesthetic bladder capacity was 723.9 cc, which was not significantly different from the final capacity of 753.1 cc (p=.15).
Among patients who completed AUA symptom questionnaires before and after hydrodistention, the symptom score improved from 17.1 before treatment to 14.3 post-hydrodistention (p<.001) and the quality of life score improved from 4.3 to 3.6 (p<.001).
“One of the things we want to do in the future, and what we’re working on, is building this database out to try to understand how we can predict who will benefit from hydrodistention,” Kirk told Urology Times. “We’re working to do multivariable modeling techniques to try to understand what the contributions of various clinical and demographic factors are in terms of being able to predict symptomatic response.”
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