title: A cohort study of interstitial cystitis/bladder pain syndrome and hysterectomy.
abstract: OBJECTIVE
  Symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS) are often confused with uterine conditions. Gynecologists may therefore recommend hysterectomy which was inappropriate for these patients. This study investigated whether IC/BPS increases the risk of hysterectomy in a large nationwide retrospective cohort study.
  
  
  METHODS
  From the Longitudinal Health Insurance Database 2010 (LHID2010) in Taiwan, we identified women diagnosed with IC/BPS between 2002 and 2013. Those with a history of hysterectomy before IC/BPS diagnosis were excluded. All women were stratified into three subgroups (younger, middle, older age) based on the propensity scores of 15 confounding factors, including age and comorbidities. All were followed until the end of 2013 to detect the event of hysterectomy. The hazard ratio (HR) of hysterectomy in the IC/BPS cohort was compared with the non-IC/BPS cohort among the three subgroups by Cox regression after adjusting for confounding factors.
  
  
  RESULTS
  In addition to the representative middle age, subgroup 2 had similar rates of comorbidities as the general population. The study was both externally and internally valid. The risk of hysterectomy in the IC/BPS cohort (n = 536) was significantly higher than in the non-IC/BPS cohort (n = 103846) in subgroup 2 (HR = 1.701, 95 % CI 1.056-2.740). The mean time to hysterectomy after diagnosis of IC/BPS was 2.97 years.
  
  
  CONCLUSIONS
  In this nationwide study, we found that IC/BPS has a causal impact on hysterectomy in the middle-age subgroup in LHID 2010. The possibility of a woman having IC/BPS should be evaluated prior to hysterectomy to avoid inappropriate surgery.
authors.affiliation: Department of Urology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.|Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China.
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China. ckmin1028@gmail.com.|Department of Obstetrics and Gynecology, Feng Yuan Hospital, Ministry of Health and Welfare, No.100, An-Kan Rd. Fengyuan Dist., Taichung City, 42055, Taiwan, Republic of China. ckmin1028@gmail.com.
authors.forename: Kun-Min
authors.initials: KM
authors.lastname: Chang
authors.affiliation: School of Medicine, Griffith University, Gold Coast, Australia.
authors.forename: Shang-Liang
authors.initials: SL
authors.lastname: Wu
authors.affiliation: Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China.
authors.forename: Hsuan-Hung
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Department of anaesthesiology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.
authors.forename: Hsiu-Ying
authors.initials: HY
authors.lastname: Lin
authors.affiliation: Department of Urology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.|Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China.
authors.forename: Huei-Ching
authors.initials: HC
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018856:Cystitis, Interstitial / Q000601:surgery*; D016208:Databases, Factual; D003951:Diagnostic Errors / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000175:diagnosis*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013624:Taiwan; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Bladder pain syndrome; Hysterectomy; Interstitial cystitis; Population-based study