Cystoscopy and bladder biopsies in patients with bladder pain syndrome carried out following ESSIC guidelines

Objective. To evaluate the cystoscopy and histology of bladder biopsies conducted following the European Society for the Study of Interstitial Cystitis/Painful Bladder Syndrome (ESSIC) recommendations. Material and methods. This prospective study at a referral centre included 50 patients, with >12 on the O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices and >7/10 on a visual analogue scale for average pelvic pain. Cystoscopic findings at hydrodistension and histological examination of biopsies were described as recommended by ESSIC and compared. Results. Performing the tests following ESSIC recommendations proved easy and offered information that permitted comparison between patients. Both cystoscopic and histological findings showed a large variation. There was no correlation between overall cystoscopic severity score and cystoscopic severity grade and the histological findings. There was a significant correlation between the cystoscopic aspect and inflammatory infiltration, mastocyte count in the detrusor muscle and stromal oedema. Maximal bladder capacity was negatively correlated with inflammation, mast cell count, haemorrhages and the overall cystoscopic aspect. In some patients cystoscopy and/or histology were normal. No information was available on patients with less severe symptoms. Conclusions. Bladder pain syndrome (BPS) patients suffering from severe symptoms represent a group with various cystoscopic findings on hydrodistension and bladder histology carried out following ESSIC recommendations. Correlations between cystoscopic findings, maximal bladder capacity and bladder histology were found. For further typing of patients with BPS cystoscopy at hydrodistension and biopsies, may be considered to be mandatory. The use of the ESSIC methodology permits a standardized investigation with results that can be compared between patients.