Changes in Urine Markers and Symptoms After Bladder Distention for Interstitial Cystitis

Erickson, Deborah R.; Kunselman, Allen R.; Bentley, Christina M.; Peters, Kenneth M.; Rovner, Eric S.; Demers, Laurence M.; Wheeler, Marcia A.; Keay, Susan K.

doi:10.1016/j.juro.2006.09.029

« Previous Next »The Journal of Urology
Volume 177, Issue 2 , Pages 556-560, February 2007

Changes in Urine Markers and Symptoms After Bladder Distention for Interstitial Cystitis

Deborah R. Erickson
- Department of Surgery, Division of Urology, University of Kentucky College of Medicine, Lexington, Kentucky
- Correspondence: Division of Urology, University of Kentucky College of Medicine, 800 Rose St., MS-269, Lexington, Kentucky 40536-0298 (telephone: 859-323-6679; FAX: 859-323-1944).
Allen R. Kunselman
- Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
Christina M. Bentley
- Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
Kenneth M. Peters
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan
- Financial interest and/or other relationship with Medtronic, Advanced Bionics, Indevus and Ortho McNeil.
Eric S. Rovner
- Department of Surgery, Division of Urology, Medical University of South Carolina, Charleston, South Carolina
- Financial interest and/or other relationship with Pfizer, Novartis, Q-Med, Indevus and Astellas.
Laurence M. Demers
- Department of Pathology and Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
Marcia A. Wheeler
- Department of Surgery, Section of Urology, Yale University School of Medicine, New Haven, Connecticut
Susan K. Keay
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine and Veterans Affairs Medical Center, Baltimore, Maryland
- Financial interest and/or other relationship with Merck Pharmaceuticals and Ortho-Clinical Diagnostics.

Received 1 March 2006

Purpose

We evaluated changes in urine markers and symptom scores after bladder distention in patients with interstitial cystitis.

Materials and Methods

Study subjects were 33 new patients who had undergone no prior interstitial cystitis treatment. Urine specimens were taken before and 1 month after bladder distention. University of Wisconsin symptom scores were done the same day as the urine specimen collection. Urine marker levels and symptom scores before and after distention were compared. Changes in markers were tested for associations with changes in symptom scores and other markers. Markers and specific symptoms before distention were tested for their association with post-distention symptom improvement.

Results

After distention the median total University of Wisconsin score decreased significantly (28.5 before, 20 after, p <0.001). A total of 12 patients (36%) had at least 30% improvement in University of Wisconsin score, and 8 patients (24%) had at least 50% improvement. No pre-distention markers or symptoms predicted which patients would have a good response. There were 2 urine markers that improved significantly after distention: anti-proliferative factor activity (median −96% before, −17% after, p <0.001) and heparin-binding epidermal growth factor-like growth factor levels (median 0.34 ng/mg creatinine before, 4.1 after, p <0.001). None of the changes in urine markers associated with changes in symptom scores.

Conclusions

The median symptom score for newly diagnosed patients with interstitial cystitis decreased after distention, but only a minority of patients had at least 30% symptom improvement. Bladder distention altered urine anti-proliferative factor activity and heparin-binding epidermal growth factor-like growth factor levels toward normal, but the mechanism of symptom relief after distention is still unknown.

Key Words: cystitis, interstitial, urine, surgery, therapy, physiopathology

Abbreviations and Acronyms: APF, anti-proliferative factor, cGMP, cyclic guanosine monophosphate, EGF, epidermal growth factor, HB-EGF, heparin-binding epidermal growth factor-like growth factor, IC, interstitial cystitis, IL-6, interleukin-6, IL-8, interleukin-8, NO, nitric oxide, UW, University of Wisconsin