膀胱镜随机活检及麻醉下水扩张对膀胱疼痛综合征／间质性膀胱炎诊治的价值

Random bladder biopsy and hydrodistention with cystoscopy under anesthesia play an important diagnostic and therapeutic role in bladder pain syndrome/interstitial cystitis

目的探讨膀胱镜随机活检及麻醉下水扩张对诊断和治疗膀胱疼痛综合征／间质性膀胱炎（bladderpainsyndrome／interstitialcystitis，BPS／IC）的临床意义。方法回顾性分析2005年至2010年我院因膀胱疼痛等下尿路症状入院的119例患者的临床资料。男32例，年龄47～64岁，平均56岁；女87例，年龄23～67岁，平均49岁。初步诊断均为BPS／IC。入院后行排尿日记、疼痛及症状评分、QOL、尿细菌学培养、尿找肿瘤细胞、尿找抗酸杆菌等检查。全麻后行膀胱镜检膀胱黏膜随机活检，然后进行膀胱镜麻醉下水扩张，对水扩张前后Ic患者每日排尿次数、最大排尿量、疼痛评分、O’Leary—Sant问卷症状评分、QOL等指标进行比较。结果119例经膀胱镜随机活检及麻醉下水扩张，确诊为Ic患者102例，治疗前每日排尿次数为（42．1±5．6）次，最大排尿量为（141．0±8．3）ml，疼痛评分为（7．6±3．0）分，O’Leary—Sant问卷症状评分为（27．7±4．2）分，QOL为（7．6±2．4）分。治疗后每日排尿次数为（23．3±3．4）次，最大排尿量为（352．0±1．7）ml，疼痛评分为（3．3±4．3）分，O’Leary—Sant问卷症状评分为（12．5±7．3）分，QOL为（3．2±5．1）分，与治疗前比较差异均有统计学意义（P〈0．05）。非Ic患者17例，确诊为膀胱尿路上皮癌8例，其中原位癌4例、低级别非浸润性膀胱癌1例、高级别浸润性膀胱癌3例，其中4例无血尿症状，膀胱疼痛症状出现至确诊的平均时间为10．8个月。确诊为结核性膀胱炎3例，嗜酸性膀胱炎1例，化学性膀胱炎3例，放射性膀胱炎2例。结论BPS仍需采用排除性诊断才能确诊为Ic。膀胱镜随机活检及麻醉下水扩张对BPS的诊疗有审要意义。

Objective To evaluate the diagnostic and therapeutic role in bladder pain syndrome/interstitial cystitis （BPS/IC） of random bladder biopsy and hydrodistention with cystoscopy under anesthesia. Methods A retrospective review of cases in our BPS/IC center was performed from 2005 to 2010. One hundred and nineteen patients were included who are diagnosed as the bladder pain syndrome/interstitial cystitis （ BPS/IC）. There were 32 male patients, aged 47 to 64 years, and 56 years on average; 87 female cases, aged 23 to 67 years , 49 years on average. Patients with bladder pain symptoms underwent a thorough evaluation which include voiding diary, pelvic pain,urgency and frequency questionnaire, urine culture, cytology, acid fast bacilli and upper tract imaging. Cystoseopy and random bladder biopsy had been undertaken with general anesthesia. Before and after hydrodistention with cystoscopy,the patients daily frequency of urination, the maximum urine volume, pain scores, symptom scores, QOL score were observed to understand whether there are significant improvement. Results One hundred and nineteen BPS/IC cases underwent random bladder biopsy and hydrodistention with cystoscopy under anesthesia,and finally 102 cases were confirmed of IC; 17 cases were not IC. Eight patients who were previously diagnosed as BPS/IC were found bladder transitional cell carcinoma as the cause of bladder pain symptoms（ including 4 cases carcinoma in situ,1 case Low grade non-invasive bladder cancer, 3 cases High grade invasive bladder cancers） , and 4 of whom had no hematuria. Mean time from the occurrence of BPS to diagnosis of transitional cell carcinoma was 10.8 months. Three patients previously diagnosed as BPS/IC were found tuberculous cystitis as the cause of symptoms, and one eosinophilic cystitis, three chemical cystitis, two radiation cystitis were also detected. Before hydrodistention with cystoscopy under anesthesia, the daily frequency of urination in 102 cases diagnosed for IC patients was 42. 1± 5.6 ; the maximum urine volume was 141.0 ± 8.3 ml; pain score 7.6 ±3. 0; O＇Leary-Sant questionnaire symptom score was 27.7 ± 4.2; QOL score was 7.6±2.4. After hydrodistention with cystoscopy under anesthesia, the daily frequency of urination in 102 IC patients was 23.3± 3.4, and the maximum urine volume was 352.0 ± 1.7 ml ; pain score was 3.3 ±4.3 ; O＇Leary-Sant questionnaire symptom score was 12.5 ±7.3 ; QOL score was 3.2 ± 5.1. Before and after hydrodistention with cystoscope under anesthesia, all of the daily frequency of urination, the maximum urine volume, pain scores, symptom scores, QOL score in 102 IC patients were significant improved （P 〈 0.05）. Conclusions BPS/IC remains a diagnosis of exclusion. Random bladder biopsy and hydrodistention with cystoseopy under anesthesia play an important diagnostic and therapeutic role in BPS/IC.