Evaluation of clinical efficacy of pelvic ultrasound monitoring combined with scale scoring in the treatment of interstitial cystitis with hydrodistention
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摘要: 目的 评价盆腔超声监测联合各类量表评分对膀胱水扩张术治疗间质性膀胱炎的临床疗效。方法 选取2019年6月—2023年6月于陕西省人民医院行膀胱水扩张术的间质性膀胱炎患者共34例，比较术前及术后3个月24 h排尿频次、夜尿频次、平均尿量及盆腔超声测量膀胱最大充盈容量、排尿后膀胱壁厚度、残余尿变化及术前和术后3个月O’Leary-Sant间质性膀胱炎评分—症状评分(ICSI)、O’Leary-Sant间质性膀胱炎指数—问题评分(ICPI)、盆腔症状评分(PUF)、疼痛视觉模拟评分(VAS)、焦虑自评量表(SAS)等变化。结果 在实施膀胱水扩张术后盆腔超声测量膀胱最大充盈容量较术前明显增加，且差异有统计学意义(P < 0.05)；术后膀胱处于空虚状态下超声测量的膀胱壁厚度较术前变薄，差异有统计学意义(P < 0.05)；充盈状态下治疗前后膀胱壁厚度变化差异无统计学意义(P>0.05)。术后3个月ICSI、ICPI、PUF、VAS、SAS等评分均较术前明显下降，且差异均有统计学意义(P < 0.05)。结论 盆腔超声监测膀胱最大充盈容量联合各类量表评分对间质性膀胱炎行膀胱水扩张术后疗效随访中有较好的指导意义。Abstract: Objective To explore the clinical efficacy of pelvic ultrasound combined with various scales in the treatment of interstitial cystitis with bladder hydrodistention.Methods A total of 34 patients with interstitial cystitis who underwent bladder hydrodistention in our hospital from June 2019 to June 2023 were selected. The preoperative and postoperative 24-hour urination frequency, nocturia frequency, average urine volume, and maximum filling bladder volume measured by pelvic ultrasound at 3 months, as well as the bladder wall thickness, residual urine changes, and the O'Leary-Sant interstitial cystitis symptom index (ICSI), O'Leary-Sant interstitial cystitis problem index (ICPI), pelvic pain and urgency/frequency (PUF), and pain visual analogue score (VAS), self-rating anxiety scale (SAS) before and after surgery were compared.Results After implementing bladder hydrodistention, the maximum filling capacity of the bladder measured by pelvic ultrasound was significantly increased compared to before surgery, and the difference was statistically significant(P < 0.05); The thickness of the bladder wall measured by ultrasound in an empty state after surgery has become thinner than before, and the difference is statistically significant(P < 0.05); There was no statistically significant difference(P>0.05) in the thickness of the bladder wall before and after treatment in a filled state. The postoperative scores at 3 months of ICSI, ICPI, PUF, VAS, SAS, etc. were significantly lower than before, and the differences were statistically significant(P < 0.05).Conclusion Pelvic ultrasound monitoring of maximum bladder capacity combined with various scales has good guiding significance for preoperative diagnosis and postoperative follow-up of interstitial cystitis.
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Key words:
- interstitial cystitis /
- ultrasound monitoring /
- hydrodistention /
- scale rating
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表 1 治疗前后24 h排尿频次、夜尿频次及最大尿量、平均尿量比较
X±S 时间 例数 24 h排尿频次 夜尿频次 最大尿量/mL 平均尿量/mL 治疗前 34 27.32±11.59 9.09±4.45 138.68±59.94 77.53±37.78 治疗后 34 11.41±3.60 2.74±1.54 346.18±94.32 222.26±67.85 Z -5.088 -4.944 -5.017 -5.013 P值 < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 治疗前后盆腔超声测量指标比较
X±S 时间 例数 膀胱最大充盈容量/mL 膀胱壁厚度(排尿后)/cm 膀胱壁厚度(排尿前)/cm 残余尿量/mL 治疗前 34 131.56±67.14 0.460±0.147 0.350±0.104 19.06±25.41 治疗后 34 267.26±60.36 0.310±0.851 0.431±0.114 11.53±14.56 Z -4.993 -2.953 -1.153 -1.573 P值 < 0.001 0.003 0.249 0.116
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表 3 治疗前后ICSI、ICPI、PUF、VAS、SAS评分比较
分，X±S 时间 例数 ICSI评分 ICPI评分 PUF评分 VAS评分 SAS评分 治疗前 34 16.94±1.28 14.65±1.39 17.41±1.28 8.35±0.77 52.44±9.44 治疗后 34 7.35±1.84 8.03±1.91 7.35±1.92 3.09±0.97 38.29±7.57 Z -5.100 -5.097 -5.102 -5.174 -4.823 P值 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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[1] Clemens JQ, Erickson DR, Varela NP, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome[J]. J Urol, 2022, 208(1): 34-42. doi: 10.1097/JU.0000000000002756
[2] Vahlensieck W. Interstitial cystitis/bladder pain syndrome (IC/BPS)[J]. Urologie, 2023, 62(6): 582-589. doi: 10.1007/s00120-023-02080-x
[3] Dias D, Mendes PA, Oliveira PD, et al. What is in the pipeline for new treatments for bladder pain syndrome/interstitial cystitis?[J]. Curr Opin Urol, 2024.
[4] Malde S, Palmisani S, Al-Kaisy A, et al. Guideline of guidelines: bladder pain syndrome[J]. BJU Int, 2018, 122(5): 729-743. doi: 10.1111/bju.14399
[5] 张龙, 杨旖欣, 闫哲, 等. 间质性膀胱炎/膀胱疼痛综合征的诊治进展[J]. 中华疼痛学杂志, 2022, 18(1): 120-128. doi: 10.3760/cma.j.cn101658-20200204-00007
[6] Pape J, Falconi G, De Mattos Lourenco TR, et al. Variations in bladder pain syndrome/interstitial cystitis (IC) definitions, pathogenesis, diagnostics and treatment: a systematic review and evaluation of national and international guidelines[J]. Int Urogynecol J, 2019, 30(11): 1795-1805. doi: 10.1007/s00192-019-03970-5
[7] 庞阳阳, 龚玉雯, 刘伟, 等. 间质性膀胱炎的治疗策略[J]. 临床泌尿外科杂志, 2017, 32(5): 400-404. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2017.05.019
[8] 徐凌, 张鹏, 张宁, 等. O'Leary-Sant问卷表在间质性膀胱炎诊断中的意义[J]. 中华医学杂志, 2013, 93(42): 3347-3350. doi: 10.3760/cma.j.issn.0376-2491.2013.42.006
[9] 杨飞, 湛海伦, 卢扬柏, 等. 心理评估在间质性膀胱炎/膀胱疼痛综合征患者诊治中的应用[J]. 中华泌尿外科杂志, 2013, 34(9): 670-673. doi: 10.3760/cma.j.issn.1000-6702.2013.09.008
[10] Fenton BW, Palmieri PA, Fanning J. Receiver operating characteristic curves of symptom scores in the diagnosis of interstitial cystitis/painful bladder syndrome[J]. J Minim Invasive Gynecol, 2008, 15(5): 601-604. doi: 10.1016/j.jmig.2008.07.004
[11] Khullar V, Chermansky C, Tarcan T, et al. How can we improve the diagnosis and management of bladder pain syndrome?Part 1: ICI-RS 2018[J]. Neurourol Urodyn, 2019, 38(Suppl 5): S66-S70.
[12] 白志明. 间质性膀胱炎/膀胱疼痛综合征诊治进展[J]. 现代泌尿外科杂志, 2023, 28(8): 643-648. doi: 10.3969/j.issn.1009-8291.2023.08.001
[13] Allen-Brady K, Fyer AJ, Weissman M. The multi-generational familial aggregation of interstitial cystitis, other chronic nociplastic pain disorders, depression, and panic disorder[J]. Psychol Med, 2023: 1-10.
[14] Tolle J, Kaftan BT, Bschleipfer T. S2K guideline on the diagnosis and treatment of interstitial cystitis (IC/BPS): discussion of the current guideline using a case study[J]. Urologe A, 2022, 61(3): 250-259. doi: 10.1007/s00120-021-01753-9
[15] Rozenberg BB, van Ginkel CJ, Janssen DAW. Restoring the barrier of chronically damaged urothelium using chondroitin sulfate glycosaminoglycan-replenishment therapy: a preclinical study using a chronic experimental model for bladder pain syndrome/interstitial cystitis and reflections on lately published similar models[J]. Curr Opin Urol, 2023.
[16] 湖北省中西医结合泌尿外科专业委员会, 中国中西医结合学会泌尿外科专业委员会. 中西医结合诊疗间质性膀胱炎专家共识[J]中国中西医结合外科杂志, 2022, 28(6): 757-762. doi: 10.3969/j.issn.1007-6948.2022.06.001
[17] Zdroik A, El Haraki A, Smith W, et al. Injection site number and outcomes of intradetrusor onabotulinumtoxinA for refractory overactive bladder syndrome: a randomized clinical trial[J]. Int Urogynecol J, 2023.
[18] Dunn M, Ramsden PD, Roberts JB, et al. Interstitial cystitis, treated by prolonged bladder distension[J]. Br J Urol, 1977, 49(7): 641-645. doi: 10.1111/j.1464-410X.1977.tb04545.x
[19] Cvach K, Rosamilia A, Dwyer P, et al. Efficacy of Clorpactin in refractory bladder pain syndrome/interstitial cystitis: a randomized controlled trial[J]. Int Urogynecol J, 2021, 32(5): 1177-1183. doi: 10.1007/s00192-020-04652-3
[20] Yamada T, Murayama T, Andoh M. Adjuvant hydrodistension under epidural anesthesia for interstitial cystitis[J]. Int J Urol, 2003, 10(9): 463-468;discussion 469.
[21] Hsu LN, Tsai YS, Tong YC. Low-pressure hydrodistension induces bladder glomerulations in female patients with interstitial cystitis/bladder pain syndrome[J]. Neurourol Urodyn, 2022, 41(1): 296-305. doi: 10.1002/nau.24818
[22] Olson LE, Dyer JE, Haq A, et al. A systematic review of the literature on cystodistension in bladder pain syndrome[J]. Int Urogynecol J, 2018, 29(2): 251-257. doi: 10.1007/s00192-017-3355-y
[23] Droz J, Howard FM. Use of the Short-Form McGill Pain Questionnaire as a diagnostic tool in women with chronic pelvic pain[J]. J Minim Invasive Gynecol, 2011, 18(2): 211-217. doi: 10.1016/j.jmig.2010.12.009
[24] Nickel JC, Shoskes D, Irvine-Bird K. Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome: a key to classification and potentially improved management[J]. J Urol, 2009, 182(1): 155-160. doi: 10.1016/j.juro.2009.02.122
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