UroToday - A prevalence study among Chinese women in Fuzhou looked at the entity of painful bladder as defined by the International Continence Society. "The complaint of suprapubic pain related to bladder filling accompanied by other symptoms such as increased daytime and night-time frequency, in the absence of proven urinary infection or other obvious pathology." Yanfeng Song and colleagues from Fuzhou, China note that a subset of patients with painful bladder syndrome have interstitial cystitis.

The distinction is the presence of "mucosal ulcers on cystoscopy, glomerulations elicited by bladder hydrodistention, and histological features by biopsy associated with IC. This viewpoint is largely in concert with that of the Japanese, though North American and European urologists do not believe that a distinction based on endoscopy or biopsy can be made to identify IC as a syndrome apart from painful bladder syndrome or bladder pain syndrome.(1-3).

The authors randomly sampled 3% of 200,000 female residents of Fuzhou, southern China, using the Bristol Female Lower Urinary Tract Symptoms questionnaire. Patients with bladder pain and at least two of urgency, frequency, and nocturia were described as having symptoms compatible with painful bladder syndrome. All of the subjects were of the Yellow Chinese Hans ethnic group, the principal ethnic group of China. Interestingly, the prevalence climbed from 0.38% in the third decade to 4.82% in the 7th decade. In multiple logistic models, parity > 2, diabetes mellitus, and smoking were correlated with painful bladder symptoms.

The authors included a nice review of recent epidemiology studies in which they proceed to compare to the reported study. They review the weaknesses of their methodology, and overall do a beautiful job of placing their data in context. BPS/IC used to be thought of as a rare disorder in Asia, but this study and the explosive interest in the disorder throughout China, Korea, Taiwan, and Japan belie that belief.

Song Y, Zhang W, Xu B, Hao L, Song
Neurourol Urodyn. 2009;28(1):22-5
10.1002/nau.20513

Reference List

(1) Hanno P, Dmochowski RR. Status of international consensus on interstitial cystitis / bladder pain syndrome / painful bladder syndrome: 2008 snapshot. Neurourol Urodyn 2008;in press.
(2) Homma Y, Ueda T, Ito T, Takei M, Tomoe H. Japanese guideline for diagnosis and treatment of interstitial cystitis. International Journal of Urology 2009;16:4-16.
(3) van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M, Daha LK, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol 2008 Jan;53(1):60-7.

UroToday Contributing Editor Philip M. Hanno, MD, MPH

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