title: Autonomic response during bladder hydrodistention reflects the severity of symptoms in patients with bladder pain syndrome/interstitial cystitis.
abstract: To evaluate the correlation between symptom severity of bladder pain syndrome/interstitial cystitis (BPS/IC) and autonomic nervous system activity, we examined autonomic responses during bladder hydrodistention.
  
  
  
  Medical records were collected from a prospective database for patients who underwent bladder hydrodistention with a fixed protocol from March 2012 to December 2013. A total of 40 patients (16 males, 24 females) were included for the analysis. Hydrodistention was performed under general anesthesia (31 patients), spinal anesthesia (six patients), and both types of anesthesia (three patients) at different times. Twenty-five patients who underwent holmium laser enucleation of the prostate served as controls. Pulse rate (PR), systolic (SBP), and diastolic blood pressure (BP) were measured pre-hydrodistention, during hydrodistention, and after drainage.
  
  
  
  The spinal anesthesia and control groups exhibited little change in BP and PR during hydrodistention, while a significant increase was demonstrated in the general anesthesia group (e.g., ΔSBP 4.89 ± 4.80, 10.40 ± 19.03, and 56.26 ± 30.38 mm Hg, respectively, P < 0.001). Under general anesthesia, autonomic response during hydrodistention was more prominent in patients with preoperative visual analogue scale (VAS) pain score ≥7, Hunner's lesion, and glomerulation grade 4. Preoperative maximal cystometric capacity negatively correlated with changes in SBP during hydrodistention (R2= 0.294, P = 0.009), while VAS score and interstitial cystitis problem index demonstrated a positive correlation with the changes (R2= 0.208, P = 0.012; R2= 0.173, P = 0.015).
  
  
  
  Under general anesthesia, exaggerated autonomic responses to bladder hydrodistention were demonstrated in BPS/IC patients, which reflected the severity of symptoms. These results support the hypothesis of altered activity of autonomic system in BPS/IC. Neurourol. Urodynam. 36:677-682, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sang Woon
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hee Seo
authors.initials: HS
authors.lastname: Son
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Irela Soto
authors.initials: IS
authors.lastname: Troya
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Ji Yu
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Myoung Joo
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Veterans Affairs Medical Center, Durham, North Carolina.|Department of Surgery, Duke University Medical Center, Durham, North Carolina.|Institute for Medical Research, Durham, North Carolina.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Fraser
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jang Hwan
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D018856:Cystitis, Interstitial / Q000175:diagnosis* / Q000503:physiopathology; D016208:Databases, Factual; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D001743:Urinary Bladder / Q000503:physiopathology*
keywords: autonomic nervous system; bladder pain syndrome; interstitial cystitis