The prevalence of interstitial cystitis, endometriosis, adhesions, and vulvar pain in women with chronic pelvic pain.
OBJECTIVE
To estimate the prevalence of bladder-origin pain, intraperitoneal pathology, and vulvar pain in patients undergoing laparoscopy for chronic pelvic pain (CPP).


METHODS
Prospective, observational one-site (Canadian Task Force classification II-2).


METHODS
Referral gynecology specialty private practice.


METHODS
Sixty-four patients undergoing laparoscopy for CPP were prospectively assessed to establish the source of their CPP over a 12-month period.


METHODS
All patients received an intravesical potassium sensitivity test (PST), cystoscopy with double-fill hydrodistension, a physical examination for vulvar pain, and laparoscopy to assess the presence of peritoneal pathology. The validated pelvic pain/urgency/frequency (PUF) screening questionnaire was given to all patients to assess symptoms.


RESULTS
Forty-four patients (69%) were found to have a positive PST indicating pain of bladder origin due to bladder epithelial dysfunction. Cystoscopic findings diagnosed only seven cases of classic interstitial cystitis (11%). Laparoscopic findings revealed biopsy-proven endometriosis in 28% and adhesions in 64%. Vulvar pain was diagnosed on examination in 20%. Assessment of intraperitoneal pathology and bladder-origin pain accurately diagnosed 95% of patients. There was no statistical difference in the prevalence of endometriosis, adhesions, or vulvar pain when groups were stratified to PST-positive or -negative groups. Bladder pain, peritoneal pathology, and vulvar pain are independent risk factors of CPP although a trend of severity was noted in patients who had worse symptoms (increased voids per day, urgency, pain, and PUF scores). Patients with increased symptoms had a higher likelihood of having pain from bladder epithelial damage and intraperitoneal pathology.


CONCLUSIONS
The etiology of CPP may arise from multiple sites in the pelvis including the bladder, pelvic peritoneum, and vulva. This study demonstrated that in a group of women undergoing a comprehensive work-up for CPP, the bladder was the predominant pain generator. A work-up for CPP should include an assessment of bladder epithelial function and an assessment for intraperitoneal pathology.
Stanford
Edward J
EJ
Department of Urogynecology/Obstetrics and Gynecology, St. Mary's/Good Samaritan Hospital, Centralia, Illinois 62801, USA.
Koziol
James
J
Feng
Anne
A
D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D018856:Cystitis, Interstitial / Q000453:epidemiology*; D003558:Cystoscopy; D004715:Endometriosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D010147:Pain Measurement; D017699:Pelvic Pain / Q000453:epidemiology* / Q000209:etiology; D010537:Peritoneum / Q000473:pathology; D011189:Potassium Chloride; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D000267:Tissue Adhesions / Q000453:epidemiology*; D014845:Vulvar Diseases / Q000453:epidemiology*
D011189:Potassium Chloride