UP-97 Using narrow band imaging during flexible cystoscopy to improve the detection of pathognomonic indicators of bladder pain syndrome: a pilot study
Thursday June 27, 2019 from
TBD
Presenter

Christopher Ciampa, Australia

Principal House Officer

Urology

Queensland Health

Abstract

Using narrow band imaging during flexible cystoscopy to improve the detection of pathognomonic indicators of bladder pain syndrome: A pilot study

Christopher Ciampa1, Anthony J Kiosoglous1.

1Urology, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia

Introduction: Bladder Pain Syndrome (BPS) is a chronic condition that affects the urinary bladder. The BPS definition continues to evolve as progressing research leads to better understanding of the condition. Diagnostic evaluation of BPS is derived from a combination of symptomology and pathognomonic findings, historically discovered at Rigid Cystoscopy and Hydrodistension under general anaesthesia. With technological advances, flexible cystoscopy (F/C) with conventional White Light Imaging (WLI) is routinely used for assessment of potential BPS patients. However, BPS remains a diagnosis of exclusion and pathognomonic signs are notoriously difficult to identify.

Method: To compare sensitivity of F/C using conventional WLI to sensitivity of F/C using Narrow Band Imaging (NBI) in the detection of pathognomonic features of BPS 85 patients (78 women, 7 men, aged 18-80 years) with BPS symptoms, randomised (over 12 months) to clusters. F/C performed by proceduralist #1 with WLI then NBI. Procedure repeated immediately by proceduralist #2 and findings recorded separately. Using PS Power and Sample Size Calculator, sample size of 67 experiments and 67 controls sufficient to reject null hypothesis with power of 0.99.

Results: Sensitivity of F/C using WLI found to be 71% (60/85 cases). Assessment using NBI modality of the same WLI positive bladders identified capillary-rich mucosa in all (100% sensitivity). NBI additionally showed capillary rich areas without ulceration in a further 21 cases (reported as normal mucosa with WLI) and subsequently associated with glomerulation and petechial haemorrhage at hydrodistension. NBI diagnosed 5 cases of biopsy confirmed bladder CIS which were missed with WLI.

Conclusions: Results suggest that detection of BPS lesions is increased by 25% when performing F/C with NBI compared with WLI (increased sensitivity of 25%). These results support inclusion of F/C with NBI in a diagnostic schema for BPS and should be further clarified with additional studies.


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