EVALUATION OF DETRUSOR OXYGENATIONIN PAINFUL BLADDER SYNDROME/INTERSTITIAL CYSTITIS
K. REBULLAR1, J.LOCKE 1, B. S. SHADGAN 2, L. STOTHERS 3,A. MACNAB 2, M. NIGRO 1;
1UrologicSciences, Univ. of British Columbia, Vancouver, Canada, 2Univ.of British Columbia, Vancouver, Canada, 3UrologicSciences, Univ. of British Columbia, Vancouver BC, Canada.
Introduction: Interstitialcystitis (IC) is associated with lower urinary tract symptoms of morethan six weeks duration in the absence of infection or otheridentifiable causes.1 Currently, IC is a clinicaldiagnosis of exclusion,2 making it more challenging forboth clinicians and patients. Near infrared spectroscopy (NIRS) is anon-invasive optical technique used in monitoring tissue oxygenationin real time.
Objective: In this pilot study we aim to usetranscutaneous NIRS in IC patients and in healthy controls todetermine if there are differences in oxygen saturation of thebladder detrusor muscle in these populations.
Methods: Werecruited 7 patients diagnosed with IC by their urologists throughthe urology clinic at a tertiary care hospital, and 7 healthycontrols matching their gender and age range. Participants were askedto complete 4 questionnaires - Interstitial Cystitis Symptom Indexand Problem Index, and the Pain, Urgency and Frequency score toassess bladder symptomatology, and a feedback survey at the end ofthe study.
An ultrasound is used to verify bladder position andpre-void volume. The NIRS is then placed over the bladder andmid-thigh to collect tissue saturation index (TSI) at rest.
Analysisof NIRS results will include description of absolute bladder andcontrol site TSI. Qualitative analysis will be used to study thesurvey satisfaction results.
Results: Patients with ICranged in age from 31 to 70 years and controls from 24 to 58 years.Patients with IC had a mean IC symptoms score index (ICSI) of 9.1(range 4 to 14) and a Pain, Urgency, and Frequency symptoms score of10.6 (range 6 to 20).
6 out of 7 IC patients had a higher TSI intheir bladder than in their mid-thigh. Meanwhile 7 out of 7 controlshad an inverse relationship. A representative graphic showing TSI andhemoglobin profile from an IC subject with a bladder TSI of 80.8% andmid-thigh TSI of 74.0% is shown in Figure 1 below. This subject ismoderately symptomatic with an ICSI score of 9 and Pain, Urgency, andFrequency score of 14.
Survey satisfaction found that 6out of 7 IC patients preferred the NIRS over providing a urine samplefor urinalysis and culture. The participants rated their NIRSexperience an average of 4.8 out of 5.
Conclusions: Thispilot study has demonstrated feasibility of non-invasive NIRSevaluation of the bladder in subjects with a history of painfulbladder syndrome/interstitial cystitis. Subjects rated NIRS as havinghigh acceptability. NIRS offers the ability to repeat measure inpatients in their clinical course as the energy source is non-toxic.Future directions include a larger clinical study evaluating IC,controls, and bacterial infection.
References: 1. NeurourolUrodyn. 2009;28: 274-286.
2. J Urol. 2015;193: 1545-1553.