ABSTRACT

Herein, we aimed to review, report, and discuss the role of cystoscopy and clinical phenotyping in interstitial cystitis/bladder pain syndrome (IC/BPS). For this purpose; a comprehensive nonsystematic review of the relevant literature was conducted. We reviewed articles published in English and indexed in the PubMed, Embase, and Google Scholar databases. Original manuscripts, review articles, case series, and case reports were taken into consideration. Data regarding the indications for, technique, and possible findings of cystoscopy with hydrodistension (HD) and biopsy, as well as clinical implications of cystoscopic information and the concept and use of clinical phenotyping within the context of IC/ BPS were extracted and discussed. IC/BPS is diagnosed based on symptomatic assessment and exclusion of confusable diseases. There is no universal agreement upon the evaluation and diagnostic algorithm of IC/BPS. The majority of the guidelines recommend cystoscopy with HD and biopsy as a diagnostic prerequisite. Various different techniques have been described for cystoscopy with HD. General or epidural anesthesia is more commonly preferred and advocated while assessing endoscopic alterations in patients suspected of having IC/BPS. Cystoscopy with HD and biopsy enables more objective exclusion of confusable diseases. It also provides the basis of the European Society for the Study of Interstitial Cystitis classification. Patients with IC/BPS who demonstrate positive cystoscopic (glomerulations and/or Hunner lesion) and histologic findings have a more severe symptomatology and may benefit from lesion-targeted endoscopic treatments. Clinical phenotyping has been implemented for IC/BPS and may be used for individualized assessment and treatment.

Keywords: Bladder pain, cystoscopy, hydrodistension, biopsy, phenotyping

Introduction

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disorder of unknown etiology and is one of the most debilitating conditions in urologic practice. It is characterized by pain, pressure or discomfort perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks’ duration, in the absence of any identifiable cause such as infection (1,2). IC/BPS can be recognized by the presence of consistent symptoms and signs. Disorders that may lead to a similar symptomatology should be excluded in order to confirm the diagnosis of IC/BPS (2).

There are significant variations regarding the evaluation and diagnosis of IC/BPS (3). The role of cystoscopy in the diagnosis and classification of IC/BPS has long been a matter of debate, with some authorities such as the European Society for the Study of Interstitial Cystitis (ESSIC) indicating cystoscopy as a diagnostic prerequisite, whereas some others, such as the American Urological Association (AUA) reserve it for complex cases (4).

Clinical phenotyping, which categorizes the disorder according to the presence or absence of clinically relevant domains, has been implemented in IC/BPS after its success for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in an effort to optimize diagnosis and treatment (5). The main purpose of phenotype mapping in IC/BPS is to better understand the multifactorial etiology of the disorder and enable multimodal and phenotype-directed targeted therapy (6).

Herein, we review and discuss the contemporary English literature about cystoscopic evaluation and clinical phenotyping in IC/BPS.

Indications for cystoscopy with hydrodistension and biopsy in IC/BPS

Technique of cystoscopy + hydrodistension in IC/BPS

Cystoscopic findings in IC/BPS

Classification of ic/bps according to findings at cystoscopy with hydrodistension and biopsies

Clinical implications and correlations regarding cystoscopy with hydrodistension and biopsy findings in IC/BPS

Clinical phenotyping in IC/BPS

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Cystoscopic evaluation and clinical phenotyping in interstitial cystitis/bladder pain syndrome