Are patient symptoms predictive of the diagnostic and/or therapeutic value of hydrodistention?

Abstract

Introduction: Hydrodistention (HD) has been utilized as a diagnostic and therapeutic tool in patients with refractory and diverse pelvic floor symptoms, including bladder pain with or without irritative bladder symptoms such as urinary urgency and urinary frequency. We sought to determine whether we could better define in whom HD was a more valuable intervention by stratifying patients according to presenting symptoms.

Materials and methods: A retrospective review was performed on 185 patients who underwent HD at our institution by a single surgeon between 1/2002-8/2004. Subjects were placed into groups according to their symptoms. Group 1 (G1) patients reported pain with bladder filling that was relieved with emptying, group 2 (G2) reported constant pelvic pain unrelated to bladder filling or emptying, and group 3 (G3) reported urgency and frequency alone with no pain component. Anesthetic capacity, presence and severity of glomerulations post-distention, and follow-up at 1, 3, and 6 months were recorded for each patient.

Results: G1 included 40 patients with mean age of 42 (R = 16-77), G2 included 101 patients with mean age of 46 (R = 20-76), and G3 22 patients with mean age of 40 (R = 20-84). The mean anesthetic capacity was 715 ml, 725 ml, and 542 ml for G1, G2, and G3 respectively. ANOVA revealed a statistically significant reduction in the capacity of G3 when compared with the others (P = 0.0072). Glomerulations were present in 74% of G1, 72% of G2, and 86% of G3 patients. 61%, 33%, & 0% of G1 patients reported improvement at 1, 3, and 6 months respectively, 54%, 25%, & 7% of G2 patients reported improvement, and 50%, 19%, & 7% of G3 patients reported improvement. There were no statistically significant differences in the responses amongst the three groups.

Conclusions: Although HD is frequently employed for patients with refractory pelvic pain and/or lower urinary tract complaints, results failed to identify any statistically significant differences in post-distention objective findings (anesthetic capacity, glomerulations) or therapeutic benefits when patients are categorized according to presenting symptoms.