Evaluation of clinical efficacy of pelvic ultrasound monitoring combined with scale scoring in the treatment of interstitial cystitis by intravesical instillation regimen combined with hydrodistention and transurethral fulguration

doi:10.21203/rs.3.rs-5283011/v1

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Research Article

Evaluation of clinical efficacy of pelvic ultrasound monitoring combined with scale scoring in the treatment of interstitial cystitis by intravesical instillation regimen combined with hydrodistention and transurethral fulguration

https://doi.org/10.21203/rs.3.rs-5283011/v1

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Background: To evaluate the clinical efficacy of pelvic ultrasound monitoring combined with various scale scores in the treatment of interstitial cystitis with intravesical instillation of heparin/alkalized lidocaine (lidocaine mixed with sodium bicarbonate) combined with hydrodistention and transurethral fulguration.

Methods: From June 2016 to June 2023, patients who were diagnosed as interstitial cystitis in urology department of the xuzhou central hospital were selected. All patients received intravesical instillation regimen of 2% lidocaine 10ml + 5% sodium bicarbonate 5ml + heparin 25000IU for 6 months, and they chose whether to receive hydrodistention and transurethral fulguration treatment according to their wishes. Patients were divided into hydrodistention and transurethral fulguration (HD/TF) group and non-HD/TF group. The 24-hour urination frequency, nocturia frequency, pelvic ultrasound measurement results (maximum filling bladder volume, bladder wall thickness after urination, residual urine volume), O'Leary-Sant interstitial cystitis symptom index (ICSI), O'Leary-Sant interstitial cystitis problem index (ICPI), pelvic pain and urgency/frequency (PUF), pain visual analogue score (VAS), self-rating anxiety scale (SAS) were recorded before treatment and 3 and 6 months after treatment.

Results: A total of 68 patients were included in this study, including 13 males (19.12%) and 55 females (80.88%), with an average age of 59.07 ± 8.15 years. 68 patients were divided into HD/TF group (n=30) and non-HD/TF group (n=38) according to whether they received hydrodistention and transurethral fulguration. After the 3rd and 6th months of treatment, the 24-hour urination frequency and nocturia frequency in both groups decreased significantly (P<0.05), and the 24-hour urination frequency and nocturia frequency after the 3rd and 6th months of treatment in HD/TF group decreased significantly compared with that in non-HD/TF group (P<0.05). After the 3rd and 6th months of treatment, the maximum filling bladder volume in the two groups increased and the residual urine volume decreased (P<0.05). In addition, the maximum filling bladder volume of the HD/TF group increased significantly compared to the non-HD/TF group after 3rd and 6th months of treatment (P<0.05), while the bladder wall thickness after urination decreased compared to the non-HD/TF group after 3rd months of treatment (P<0.05). There was no significant difference in residual urine volume between HD/TF group and non-HD/TF group before and after treatment (P>0.05). The postoperative scores at 3rd and 6th months of ICPI, ICSI, PUF, SAS and VAS in both groups were significantly lower than those before treatment (P<0.05), and The postoperative scores at 3rd and 6th months of ICPI, ICSI, PUF, SAS and VAS in HD/TF group were significantly lower than those in non-HD/TF group (P<0.05).

Conclusions: Intravesical instillation of heparin/alkalized lidocaine combined with hydrodistention and transurethral fulguration is an effective treatment for interstitial cystitis, which can significantly reduce patient pain and improve patient prognosis. Moreover, the use of pelvic ultrasound to monitor indicators such as maximum filling bladder volume and residual urine volume, combined with ICSI, ICPI, PUF, VAS, and SAS scores, has high application value for evaluating the efficacy of intravesical instillation regimen combined with hydrodistention and transurethral fulguration in the treatment of interstitial cystitis.

Interstitial cystitis

Intravesical instillation

Transurethral fulguration

Hydrodistention

Scale scoring

Pelvic ultrasound monitoring

Interstitial cystitis (IC), also known as bladder pain syndrome (BPS), is a chronic pelvic disease related to bladder. Its clinical manifestations are bladder discomfort, compression or pain, and it has been included in the category of chronic pelvic pain in the guidelines issued by the European Association of Urology (EAU) ^{1, 2, 3}. IC is characterized by chronic inflammation and lower urinary tract symptoms (such as frequent micturition, urgency, etc.), and its etiology and pathogenesis are still unclear ¹. At present, relevant research shows that it may be the result of a combination of multiple causes and pathogenesis, and its histological characteristics are bladder wall fibrosis and decreased bladder capacity ^{4, 5}. Because of the long course of disease and serious clinical symptoms of interstitial cystitis, and the pathogenesis of interstitial cystitis is not clear at present, although there are many treatment methods at this stage, the treatment effect is still poor and easy to relapse, which seriously affects the physical and mental health and quality of life of patients ².

At present, the treatment of interstitial cystitis is mainly to relieve symptoms. First-line oral drugs such as amitriptyline, hydroxyzine, cyclosporine and pentosan polysulfate sodium have been proved to only improve the pain symptoms of patients by 30%-68%, and some patients will have toxic and side effects such as dry mouth, allergy, gastrointestinal dysfunction and obesity during the treatment ^{6, 7, 8}. And long-term treatment will bring heavy economic burden to patients' families and society. In China, the cost of heparin/alkali lidocaine combination therapy is about 1/90 of that of hyaluronic acid, which has been applied to the treatment of interstitial cystitis and achieved good results ⁹. Based on this, this study analyzed the clinical efficacy of intravesical infusion of heparin/alkalized lidocaine (lidocaine mixed with sodium bicarbonate) combined with hydrodistention and transurethral fulguration in the treatment of interstitial cystitis, and evaluated the efficacy by measuring the maximum filling bladder volume, residual urine volume and bladder wall thickness after urination combined with ICSI, ICPI, PUF, VAS, SAS scoring scales.

2.1 Data collection

From June 2016 to June 2023, 68 patients with interstitial cystitis in urology department of the xuzhou central hospital were selected, including 13 males (19.12%) and 55 females (80.88%), with an average age of 59.07 ± 8.15 years. Inclusion criteria: ① All patients met the diagnostic criteria of interstitial cystitis ¹; ② Frequent urination (more than 8 times a day), nocturia (more than 2 times during sleep), urgency, bladder pain, etc. for more than 9 months; ③ Under local anesthesia, Hunner lesion or globular hemorrhage of bladder mucosa can be seen by cystoscopy; ④ The case data is perfect, and the scores of various scales are perfect. Exclusion criteria: ① urinary tract diseases such as urinary tract infection, urinary tract tumor and calculus; ② Chronic bladder pain caused by other reasons; ③ The medical history is less than 6 months; ④ Urodynamic residual urine volume is greater than 350mL. This study followed the ethical standards of Helsinki Declaration, and all patients were informed and signed the relevant consent before treatment.

2.2 Research method

All patients received intravesical infusion of 2% lidocaine 10ml + 5% sodium bicarbonate 5ml + heparin 25000IU for 6 months, and the infusion was kept in the bladder for 60min once or twice a week for 8 weeks, and then maintained once or twice a month for 6 months. According to patients' wishes, patients were divided into two groups: hydrodistention and transurethral fulguration (HD/TF) group (n = 30) and non-HD/TF group (n = 38). Among them, HD/TF group received hydrodistention treatment with physiological saline under general anesthesia. The standard for hydrodistention was to keep the bladder filled for 3 minutes under a pressure of 80cmH₂O (1cmH₂O = 98Pa), and there would be waterfall bleeding of Hunner focus ¹⁰ or diffuse bleeding of bladder mucosa under the microscope. The Hunner focus and suspicious focus were resected for pathology, and then all suspicious focus were treated with electrocautery. Compare the 24-hour urination frequency, nocturia frequency, pelvic ultrasound measurement results (maximum filling bladder volume, bladder wall thickness after urination, residual urine volume), and O'Leary-Sant interstitial cystitis symptom index (ICSI), O'Leary-Sant interstitial cystitis problem index (ICPI), pelvic pain and urgency/frequency (PUF), pain visual analogue score (VAS), self-rating anxiety scale (SAS) between two groups of patients before and 3rd and 6th months after treatment.

2.3 Outcome indicators

The severity of symptoms was evaluated by ICSI, ICPI, PUF, VAS and SAS scores. All patients were investigated from the beginning of treatment, and were followed up 3rd and 6th months after treatment, respectively. And we used various indicators from the week before treatment as baseline indicators.

2.3.1 Pelvic ultrasound indicator measurement

When the patient was told to hold the urine to the maximum tolerance before pelvic ultrasound examination, the maximum filling bladder volume was measured by ultrasound. After obtaining the data, the patient was told to empty the bladder and measure the residual urine volume and the bladder wall thickness after urination again.

2.3.2 Urination diary record

Ask the patient to record the urination time within 24 hours (accurate to minutes) in detail for 3 days. The data of 24-hour total urination frequency and nighttime urination frequency in urination diary were counted.

2.3.3 ICSI

ICSI ¹¹ mainly evaluates the severity of symptoms such as the frequency of strong urine sensation, the duration of urination interval, the frequency of nocturnal urination, bladder pain, etc. Each score is divided into 0 ~ 5 points according to the severity, and finally the total score is counted, with the highest score of 20 points. The higher the score, the more serious the symptoms are.

2.3.4 ICPI

ICPI ¹¹ refers to the degree of distress of patients with symptoms such as frequent urination during the day and at night, urination without warning and bladder pain. Each item is divided into 0 ~ 4 points according to the severity, and the total score is 16 points. The higher the score, the heavier the distress.

2.3.5 PUF

A questionnaire on symptoms of patients with pelvic pain, frequent micturition and urgency was used. There were 8 questions in the questionnaire, covering the correlation between daytime and nighttime micturition frequency, sexual intercourse pain, pelvic pain and urgency after defecation. The final score was the sum of symptom score and distress score, in which the symptom score was the sum of questions 1 + 2a + 4a + 5 + 6 + 7a + 8a. The puzzle score is the sum of the scores of question 2b + 4b + 7b + 8b.

2.3.6 VAS

VAS ¹² was used to evaluate the pain of the maximum degree of urination, and the score was 0 ~ 10, with 0 being painless and 10 being unbearable. Patients score their pain status according to the pain degree of each part of the pelvic cavity according to their maximum degree of urination.

2.3.7 SAS

SAS ¹³ was used to evaluate anxiety, and the scale consisted of 20 items, which were scored in grades 1, 2, 3 and 4. Scoring result: < 50 is normal; 50 ~ 59 is divided into mild anxiety; > 59 ~ 69 is divided into moderate anxiety; > 69 is divided into severe anxiety.

2.4 Statistical analysis

SPSS 26.0 software was used for statistical analysis. The normally distributed measurement data were expressed as (x ± s), and the t test was used for the comparison between groups. P < 0.05 was statistically significant.

3.1 Comparison of urinary frequency between two groups before and after treatment

Before treatment, there was no significant difference between the non-HD/TF group and the HD/TF group in the 24-hour urination frequency and the nocturia frequency (P > 0.05). However, the 24-hour urination frequency and nocturia frequency in the two groups were significantly decreased after the 3rd and 6th months of treatment (P < 0.05). The 24-hour urination frequency in HD/TF group after the 6th months of treatment was higher than that after the 3rd months of treatment (P < 0.05). In addition, the 24-hour urination frequency and the nocturia frequency after the 3rd and 6th months of treatment in HD/TF group was significantly lower than that in non-HD/TF group (P < 0.05), as shown in Table 1.

Table 1

Comparison of 24-hour urination frequency and nocturia frequency between the two groups before and after treatment.
Variable	24-hour urination frequency			Nocturia frequency
Variable	Before	The 3rd month	The 6th month	Before	The 3rd month	The 6th month
Non-HD/TF group	18.57 ± 3.06	15.26 ± 1.81*	14.95 ± 2.27	6.05 ± 1.21	4.47 ± 0.89*	4.50 ± 0.73
HD/TF group	18.42 ± 2.97	10.93 ± 2.24*	12.85 ± 2.53**	5.97 ± 1.52	2.57 ± 0.94*	2.80 ± 0.76
t	0.209	8.810	3.600	0.260	8.566	9.386
P	0.835	< 0.001	< 0.001	0.796	< 0.001	< 0.001
*Note: represents the comparison before treatment and * * represents the comparison with the third month after treatment, and the difference is statistically significant, that is, P < 0.05.**

3.2 Comparison of maximum filling bladder volume, bladder wall thickness after urination and residual urine volume between the two groups before and after treatment by pelvic ultrasound

Before treatment, there was no significant difference between non-HD/TF group and HD/TF group in the maximum filling bladder volume, residual urine volume and bladder wall thickness after urination (P > 0.05). After the 3rd and 6th months of treatment, the maximum filling bladder volume in the two groups increased, while the residual urine volume decreased, with statistical significance (P < 0.05). After the 6th months of treatment, the maximum filling bladder volume and residual urine volume of the two groups were lower than those after 3rd months of treatment, and the difference was statistically significant (P < 0.05). And the maximum filling bladder volume in HD/TF group was significantly higher than that in non-HD/TF group after the 3rd and 6th months of treatment (P < 0.05). In HD/TF group, the bladder wall thickness after urination increased after 6th months of treatment compared with 3rd months of treatment, and the difference was statistically significant (P < 0.05). After the 3rd month of treatment, the bladder wall thickness after urination in HD/TF group was lower than that of non-HD/TF group, and the difference was statistically significant (P < 0.05). In the non-HD/TF group, there was no significant change in the the bladder wall thickness after urination at the 3rd and 6th month after treatment, and the difference was not statistically significant (P > 0.05), as shown in Table 2.

Table 2

Comparison of pelvic ultrasound measurement indexes between the two groups before and after treatment.
Variable	Maximum filling bladder volume			Residual urine volume
Variable	Before	The 3rd month	The 6th month	Before	The 3rd month	The 6th month
Non-HD/TF group	112.42 ± 22.50	253.97 ± 27.11*	209.32 ± 26.93**	17.76 ± 3.24	12.80 ± 2.93*	9.78 ± 0.77**
HD/TF group	104.37 ± 20.11	294.70 ± 29.64*	232.30 ± 22.06**	18.89 ± 2.51	13.77 ± 1.89*	10.09 ± 0.86**
t	1.535	-5.904	-3.779	-1.578	-1.570	-1.557
P	0.130	< 0.001	< 0.001	0.119	0.121	0.124

Variable	bladder wall thickness after urination
Variable	Before	The 3rd month	The 6th month
Non-HD/TF group	0.47 ± 0.06	0.46 ± 0.06	0.45 ± 0.05
HD/TF group	0.46 ± 0.07	0.33 ± 0.06*	0.44 ± 0.07**
t	0.432	8.665	0.942
P	0.667	< 0.001	0.350
*Note: represents the comparison before treatment and * * represents the comparison with the third month after treatment, and the difference is statistically significant, that is, P < 0.05.**

3.3 Comparison of ICPI, ICSI, PUF, VAS and SAS before and after treatment between the two groups

Before treatment, there was no significant difference in ICPI, ICSI, PUF, VAS and SAS between non-HD/TF group and HD/TF group (P > 0.05). The scores of ICPI, ICSI, PUF, SAS and VAS at the 3rd and 6th month after treatment in the two groups were significantly lower than those before operation, and the differences were statistically significant (P < 0.05). And the ICPI, ICSI, PUF and SAS at the 6th month after treatment in the two groups were significantly lower than those at the 6th month after treatment, and the differences were statistically significant (P < 0.05). There was no significant difference in VAS between the two groups after the 3rd and 6th month of treatment (P > 0.05). The scores of ICPI, ICSI, PUF, SAS and VAS in HD/TF group were significantly lower than those in non-HD/TF group after the 3rd and 6th months of treatment, and the differences were statistically significant (P < 0.05), as shown in Table 3.

Table 3

Comparison of ICPI, ICSI, PUF, VAS and SAS scores between the two groups before and after treatment.
Variable	ICPI			ICSI
Variable	Before	The 3rd month	The 6th month	Before	The 3rd month	The 6th month
Non-HD/TF group	14.11 ± 1.27	8.11 ± 0.83*	7.45 ± 0.95**	15.39 ± 1.13	7.26 ± 0.98*	6.18 ± 0.83**
HD/TF group	14.43 ± 1.14	7.40 ± 0.86*	6.47 ± 0.86**	15.60 ± 1.13	6.23 ± 1.01*	5.27 ± 0.98**
t	-1.108	3.430	4.404	-0.744	4.258	4.170
P	0.272	0.001	< 0.001	0.460	< 0.001	< 0.001

Variable	PUF			VAS
Variable	Before	The 3rd month	The 6th month	Before	The 3rd month	The 6th month
Non-HD/TF group	17.34 ± 0.99	7.45 ± 1.01*	6.53 ± 0.95**	6.92 ± 0.82	2.92 ± 0.67*	2.84 ± 0.72
HD/TF group	17.47 ± 1.20	6.17 ± 0.87*	5.10 ± 0.85**	7.27 ± 1.02	2.17 ± 0.75*	2.10 ± 0.76
t	-0.469	5.520	6.446	-1.555	4.373	4.128
P	0.641	< 0.001	< 0.001	0.125	< 0.001	< 0.001

Variable	SAS
Variable	Before	The 3rd month	The 6th month
Non-HD/TF group	54.53 ± 4.67	41.39 ± 4.91*	33.16 ± 5.59**
HD/TF group	56.43 ± 5.33	34.90 ± 2.52*	27.27 ± 5.23**
t	-1.571	6.587	4.439
P	0.121	< 0.001	< 0.001
*Note: represents the comparison before treatment and * * represents the comparison with the third month after treatment, and the difference is statistically significant, that is, P < 0.05.**

IC is a chronic pelvic pain syndrome with unknown etiology, which mainly manifests as chronic pelvic pain lasting for more than 6 months, often accompanied by abnormal urination (such as frequent micturition, urgency and nocturia, etc.), and its symptoms recur, leading to anxiety and depression in most patients, which seriously affects the quality of life of patients ^{14, 15, 16}. Because the pathogenesis and etiology of IC are uncertain, the diagnosis and treatment of IC has always been a difficult problem for medical staff. At present, there is no standard etiology treatment method, and it can not be cured. The principle of clinical treatment is to improve symptoms and improve the quality of life of patients. At present, the treatment methods of IC mainly include conservative treatment and surgical operation. Among them, the commonly used conservative treatment is intravesical instillation therapy, which is widely used in clinic because of its characteristics of safety, non-invasion and few complications. Some intravesical instillation drugs such as chondroitin sulfate ¹⁷, pentosan polysulfate sodium ⁸, hyaluronic acid ¹⁸ and heparin ¹⁹ have been widely used in the treatment of interstitial cystitis, and achieved good therapeutic effects. However, the efficacy of these drugs can not be maintained for a long time, and usually gradually weakens with the extension of time. At present, in China, only hyaluronic acid and heparin are approved for the treatment of intravesical instillation in IC patients, and heparin is easier to obtain and cheaper than hyaluronic acid (only 1/180 of hyaluronic acid). In addition, intravesical instillation of alkalized lidocaine (lidocaine mixed with sodium bicarbonate) is also effective for IC patients ⁹. Different from heparin, intravesical injection of lidocaine (a local anesthetic) can reduce the excitability of bladder sensory nerve endings, thus helping to alleviate the intensity and frequency of pain related to IC. In alkaline environment, lidocaine can pass through the cell membrane more smoothly, which means that alkalized lidocaine has therapeutic potential for controlling the symptoms caused by IC. Parsons et al. ⁹ have applied the mixture of lidocaine, heparin sodium and sodium bicarbonate to treat interstitial cystitis, and achieved good results. Among the surgical operations, hydrodistention of bladder is widely used to treat interstitial cystitis (especially recurrent and refractory) in recent years, and it is reported that the curative effect is about 71% one month after hydrodistention ^{20, 21}.

The treatment scheme adopted in this study is intravesical instillation of heparin/alkalized lidocaine (lidocaine mixed with sodium bicarbonate) combined with hydrodistention and transurethral fulguration. On the one hand, heparin is a sulfated polysaccharide and a glycosaminoglycan analog, which can enhance the protection of natural bladder mucosa and help to repair bladder epithelium; On the other hand, alkalized lidocaine can lower the sensory nerve threshold of bladder; The combination of the two can significantly accelerate the process of down-regulation of bladder sensory nerve threshold. In this study, it can be observed that the scores of ICPI, ICSI, PUF, SAS and VAS after intravesical instillation of heparin and alkalized lidocaine were significantly lower than those before treatment (P < 0.05), and decreased significantly at the 3rd month after treatment, and maintained a downward trend for half a year. It shows that intravesical infusion of heparin and alkalized lidocaine can relieve pain more quickly and obviously, and it lasts for a long time. Some scholars have found that there are defects in the GAG layer of bladder mucosa of IC patients, which will lead to frequent urination, urgency, nocturia and pain ²². As a GAG analog, heparin can relieve neurogenic inflammation and prevent the activation of subcutaneous mast cells on the urinary tract of bladder, thus alleviating IC pian symptoms. Hyaluronic acid, as another analogue of GAG, has similar effect to heparin. In China, the cost of heparin/alkali lidocaine is about 1/90 of that of hyaluronic acid. Considering its low cost, long-lasting effect and satisfactory curative effect, heparin/alkali lidocaine is expected to become the first choice for bladder perfusion treatment, and can significantly reduce the economic burden of patients and medical insurance system.

In this study, the HD/TF group was combined with hydrodistention and transurethral fulguration on the basis of intravesical instillation of heparin and alkalized lidocaine. All patients underwent bladder water injection test before hydrodistention. If the patients were positive, hydrodistention was prohibited. During the hydrodistention, the bladder was kept full for 3 minutes under the perfusion pressure of 80cmH₂O. The observed Hunner lesions or suspicious lesions were treated with electrocautery and pathological examination with the help of cystoscope. Whether the bladder capacity increases after treatment is a common index to evaluate the objective curative effect of IC in clinic. Catheterization and indwelling catheter are commonly used to measure the bladder capacity in clinic, which has the advantage of high measurement accuracy. In this study, pelvic ultrasound was used to measure the bladder capacity in the maximum filling state before and after treatment. The results showed that the maximum filling bladder volume in HD/TF group and non-HD/TF group increased significantly after treatment, and the maximum filling bladder volume in HD/TF group increased more significantly, indicating that HD/TF technology can have a positive synergistic effect on the treatment of IC symptoms. By comparing the changes of 24-hour urination frequency and nocturnal urination frequency between the two groups, we found that the 24-hour urination frequency and nocturnal urination frequency were significantly reduced after treatment, especially in HD/TF group. Considering that it is related to the increase of the maximum filling bladder volume, the bladder capacity of patients can be further expanded by hydrodistention treatment, thus reducing the frequency of urination, which is consistent with previous literature reports ²³. In addition, by comparing the changes of bladder wall thickness after urination in HD/TF group before and after treatment, it was found that the bladder wall thickness after urination was thinner at 3rd months after treatment, and was thicker at 6th months after treatment, with statistical significance (P < 0.05). The author thinks that the thinning of bladder wall thickness after urination at 3rd months after treatment may be related to the tearing of bladder mucosa caused by hydrodistention, while the thickening of bladder wall thickness after urination at 6th months after treatment may be related to the fibrosis of bladder wall after repeated hydrodistention, which is consistent with relevant literature reports ²⁴. However, there was no significant change in bladder wall thickness after urination in non-HD/TF group before and after treatment. Compared with the preoperative and postoperative residual urine volume of the two groups, it was found that the postoperative residual urine volume decreased, but the difference between HD/TF group and non-HD/TF group was not statistically significant (P > 0.05), indicating that hydrodistention generally did not increase the risk of postoperative urinary retention. In a word, pelvic ultrasound has a good guiding significance for IC patients in both preoperative diagnosis and postoperative follow-up, and ultrasound is simple, time-consuming, non-invasive, economical, highly accepted by patients and good in compliance, and can be used as an effective method for diagnosis screening and curative effect evaluation.

Although the clinical manifestations of IC are diverse and differentiated, it has typical symptoms such as "pelvic pain, frequent urination and urgency", so various symptom scores and questionnaires are widely used in the clinical diagnosis and treatment evaluation of IC diseases, such as ICSI score, ICPI score, VAS score and PUF score ^{25, 26}. In this study, the scores of ICPI, ICSI, PUF, SAS and VAS in HD/TF group and non-HD/TF group were counted before and after treatment. The results showed that the scores of ICPI, ICSI, PUF, SAS and VAS in the two groups after the 3rd and 6th months of treatment were significantly lower than those before treatment (P < 0.05), which showed that the above scores were useful for the follow-up of IC patients after treatment. In addition, the scores of ICPI, ICSI, PUF, SAS and VAS in HD/TF group were significantly lower than those in non-HD/TF group after the 3rd and 6th month of treatment (P < 0.05), which indicated that HD/TF technology and intravesical heparin and alkalized lidocaine could produce positive synergy in the treatment of IC. Although the therapeutic mechanism of hydrodistention is not clear, it has been proved to cause damage to submucosal plexus in animal experiments, which is considered to relieve pain and reduce the frequency of pain ²⁷. Some studies have also shown that the sensory nerve endings of the bladder are destroyed after hydrodistention, which reduces the sensitivity of the bladder to pain and achieves the purpose of relieving pain ⁵.

Finally, through SAS score, we can find that a large number of IC patients are complicated with mild-moderate anxiety, which may be related to the long course of the disease, frequent urination and prominent pelvic pain symptoms. Anxiety assessment in patient diagnosis and postoperative follow-up is helpful to better understand the patient's psychological state, guide us to pay attention to the patient's mental health in patient management and disease treatment, and strengthen education and propaganda. Guide patients to adjust their mentality and face the disease positively, and if necessary, ask professional psychiatrists to consult and apply anti-anxiety drugs to improve patients' anxiety symptoms, so as to improve their quality of life, and making a good VAS score before and after operation is also of certain guiding significance for the adjustment of treatment schemes for patients with anxiety.

In this study, the clinical efficacy of pelvic ultrasound combined with various scales in the treatment of interstitial cystitis by intravesical instillation of heparin/alkalized lidocaine combined with hydrodistention and transurethral fulguration has reached obvious conclusions, but there are still some limitations. For example, this study is a single-center and small-sample study, which may lead to deviations in the results, and further verification is needed by further combining multi-centers and expanding the number of cases.

In summary, heparin/alkalized lidocaine has good curative effect and low cost, and can be used as the first choice for intravesical instillation treatment, and can obviously reduce the economic and medical insurance burden of patients. However, the treatment of interstitial cystitis by heparin/alkali lidocaine intravesical instillation combined with hydrodistention and transurethral fulguration can relieve the symptoms for a relatively long time, and pelvic ultrasound monitoring of maximum filling bladder volume, bladder wall thickness after urination and residual urine volume combined with ICSI, ICPI, PUF, VAS and SAS scores have high application value for the follow-up of heparin/alkali lidocaine intravesical instillation combined with hydrodistention and transurethral fulguration in the treatment of IC.

Author Contributions：

L L: study design, data collection and manuscript writing. L L, L X, Jh Z, Bz D, Y L and Zg L: data collection and manuscript review. Y D and Ch H: data collection and analysis.

Acknowledgements

The authors would like to thank all colleagues for data collection from the Department of Urology, Xuzhou Central Hospital.

Declaration of Competing Interest

The authors declare no conflicts of interest.

Funding

This work was supported by the Xuzhou Youth Medical Science and Technology Innovation Project (NO. XWKYHT20220111) and the Pengcheng Talent - Medical Young Reserve Talent Training Project (No. XWRCHT20220012).

Ethical approval

This study was conducted according to the ethical principles of medical research involving human subjects in the Declaration of Helsinki and have been approved by the biomedical ethics committee of the Xuzhou Central Hospital (Number: 2024-087). Patients and their families signed informed consent before operation.

Consent

Written consent has been received from the subject.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Written informed consent for publication was obtained from the participant.

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No competing interests reported.

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Evaluation of clinical efficacy of pelvic ultrasound monitoring combined with scale scoring in the treatment of interstitial cystitis by intravesical instillation regimen combined with hydrodistention and transurethral fulguration

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Version 1

Abstract

1. Introduction

2. Materials and Methods

2.1 Data collection

2.2 Research method

2.3 Outcome indicators

2.3.1 Pelvic ultrasound indicator measurement

2.3.2 Urination diary record

2.3.3 ICSI

2.3.4 ICPI

2.3.5 PUF

2.3.6 VAS

2.3.7 SAS

2.4 Statistical analysis

3. Results

3.1 Comparison of urinary frequency between two groups before and after treatment

4. Discussion

Declarations

References

Additional Declarations

Status:

Version 1