What condition is evaluated by hydrodistention and cystoscopy (Cystoscopy)?

From the Guidelines

Hydrodistention with cystoscopy is primarily used to evaluate and diagnose interstitial cystitis/bladder pain syndrome (IC/BPS) 1. This procedure involves filling the bladder with fluid under pressure while performing cystoscopy to directly visualize the bladder lining. During the examination, the physician looks for characteristic findings such as glomerulations (pinpoint bleeding sites), Hunner's lesions (distinctive inflammatory lesions), and reduced bladder capacity, all of which are hallmarks of IC/BPS. The procedure serves both diagnostic and therapeutic purposes, as the distention itself can temporarily relieve symptoms in some patients by stretching tight bladder tissue and potentially disrupting pain signaling pathways. Additionally, hydrodistention with cystoscopy helps exclude other conditions that may mimic IC/BPS symptoms, such as bladder cancer, urinary tract infections, or bladder stones 1. Some key points to consider when evaluating the use of hydrodistention with cystoscopy include:

• The procedure is typically performed under anesthesia
• It may provide symptom relief lasting weeks to months for some patients, though results vary considerably between individuals 1
• Cystoscopy has a high sensitivity and specificity for detecting bladder cancer, ranging from 87% to 100% and 64% to 100%, respectively 1
• Possible complications of cystoscopy include pain and discomfort, haematuria, dysuria, and urinary tract infection 1 The most recent and highest quality study 1 supports the use of hydrodistention with cystoscopy for the evaluation and diagnosis of IC/BPS, and this procedure is a valuable tool in the management of this condition.

From the FDA Drug Label

All patients met the NIH definition of IC based upon the results of cystoscopy, cytology, and biopsy. The condition evaluated by hydrodistention and cystoscopy (Cystoscopy) is Interstitial Cystitis (IC) 2.

• Key points:
  • Cystoscopy is used to evaluate Interstitial Cystitis (IC)
  • The NIH definition of IC is based on the results of cystoscopy, cytology, and biopsy
  • Hydrodistention is also used in the evaluation of IC, although the specific details of this procedure are not provided in the given text.

From the Research

Condition Evaluated by Hydrodistention and Cystoscopy

The condition evaluated by hydrodistention and cystoscopy is Interstitial Cystitis/Painful Bladder Syndrome (IC/BPS) 3, 4, 5, 6, 7.

Characteristics of Interstitial Cystitis/Painful Bladder Syndrome

• Interstitial cystitis/painful bladder syndrome affects more than 1 million persons in the United States, but the cause remains unknown 4
• Most patients with interstitial cystitis/painful bladder syndrome are women with symptoms of suprapubic pelvic and/or genital area pain, dyspareunia, urinary urgency and frequency, and nocturia 4
• The diagnosis is difficult and often is one of exclusion 7

Diagnostic Tools

• Tests and tools commonly used to diagnose interstitial cystitis/painful bladder syndrome include:
  • Specific questionnaires developed to assess the condition
  • The potassium sensitivity test
  • The anesthetic bladder challenge
  • Cystoscopy with hydrodistension 4
• Cystoscopy is the best way to confirm the diagnosis 7

Treatment Options

• Treatment options include:
  • Oral medications (e.g. pentosan polysulfate sodium, antihistamines, tricyclic antidepressants, and immune modulators) 4, 7
  • Intravesical instillations (e.g. dimethyl sulfoxide, pentosan polysulfate sodium, and heparin) 4, 7
  • Dietary changes and supplements 4
  • Hydrodistention 3, 5, 6, 7
  • Sacral neuromodulation 7
  • Intradetrusor onabotulinumtoxinA 7