THE PREVALENCE OF INTERSTITIAL CYSTITIS, ENDOMETRIOSIS, ADHESIONS, AND VULVAR VESTIBULITIS IN PATIENTS UNDERGOING LAPAROSCOPY FOR CHRONIC PELVIC PAIN.

Edward J. Stanford, MD

   Objective: To establish the prevalence of uroepithelial bladder dysfunction, intraperitoneal pathology, and vulvar pain in patients undergoing laparoscopy for chronic pelvic pain.

   Materials and Methods: Forty-six patients undergoing laparoscopy for CPP were assessed for multiple sources of their chronic pain including interstitial cystitis (IC), endometriosis, adhesions, and vulvar vestibulitis. All patients had a K+ sensitivity challenge and cystoscopy to diagnose IC and were triaged into K+ positive (Kpos) or K+ negative (Kneg) responders.

   Results: Thirty patients (65%) were K+ positive (Kpos) and 16 (35%) were K+ negative (Kneg). Only 6 (20%) of the Kpos and 1 (6%) of the Kneg group met cystoscopic criteria for IC (p=0.21). Biopsy proven endometriosis was similar in both groups (Kpos = 7 (23%), Kneg = 6 (38%)(p=0.32). Adhesions were seen in 21 (70%) of the Kpos and 8 (50%) of the Kneg groups (p=0.19). No pathology at laparoscopy was found in 4 (13%) of the Kpos and 3 (19%) of the Kneg patients. Daily voids were significantly higher in the Kpos vs the Kneg group (12.5 SD 5.1 vs 8.63 SD 3.98, p=0.013). The validated pelvic pain/urgency/frequency questionnaire (PUF) scores were also statistically higher in the Kpos group (20.27 SD 4.86) vs Kneg (15 SD 7) (p=0.01). Vulvar vestibulitis was significantly more prevalent in the Kpos (n=7) vs Kneg patients (n=3) (p=0.04).

   Conclusion: The etiology of CPP may arise from multiple sites in the pelvis including the bladder, pelvic peritoneum, and the vulva. Patients with CPP have a high incidence of uroepithelial dysfunction as demonstrated by a positive K+ sensitivity test with a low incidence of cystoscopically proven IC. This is expected since cystoscopy may miss early IC. The incidence of endometriosis, adhesions, and negative laparoscopy is similar in both groups. Endometriosis is not as prevalent as has been previously reported in IC patients. These associations may support the theory of viscerovisceral hyperalgesia however, demonstrates that the bladder is a predominant pain generator in patients with CPP.