Sex differences in cystoscopic findings among Veterans with interstitial cystitis

Abstract:Purpose: Previous studies have found significant sex differences in symptoms among patients with interstitial cystitis/bladder pain syndrome (IC/BPS). However, whether this translates into differences in pathology as observed on cystoscopy is unknown. We sought to assess cystoscopic findings in veterans diagnosed with IC/BPS and to identify possible sex differences in cystoscopic findings. Methods: This was a retrospective study of all hospital visits in the Veteran Health Affairs Hospital System between October 2004 and July 2016. Patients with IC/BPS were identified from the Veteran Informatics and Computing Infrastructure (VINCI) system using appropriate ICD codes. Patients older than 18 years of age with a confirmed diagnosis of IC/BPS who underwent cystoscopy were included. Rates of cystoscopic findings of ulceration, glomerulation, inflammation, trabeculation, and tumors adjusted for patient demographics were analyzed. Results: A total of 570 patients met inclusion criteria and underwent analysis (57.9% female). The female cohort was of younger age (48.0 vs. 63.0 years). After adjusting for age, men and women had a similar likelihood of presenting with Hunner's lesions (8.2% for men and 3.7% for women, p>0.05). They also had a similar likelihood of glomerulation (11.4% in men vs. 15.2% in women, p=0.05) and inflammation (19.6% vs. 15.8%, p>0.05). Men were significantly more likely to present with trabeculation (15.4% vs. 8.1%, p=0.03). Urothelial tumors on cystoscopy were rare in both groups. Conclusion: The proportion of patients with ulceration on cystoscopy in this study is consistent with previously published studies, and our study showed a similar prevalence of Hunner's lesions between men and women. Cystoscopic identification of Hunner's lesions is an important aspect of IC/BPS management given that treatment directed that these lesions is relatively successful compared to other treatments.