Sex Differences in Cystoscopic Findings Among Veterans With Interstitial Cystitis

Purpose Previous studies have found significant sex differences in symptoms among patients with interstitial cystitis/bladder pain syndrome (IC/BPS). However, whether this translates into differences in pathology as observed on cystoscopy is unknown. We sought to assess cystoscopic findings in veterans diagnosed with IC/BPS and to identify possible sex differences in cystoscopic findings. Methods This was a retrospective study of all hospital visits in the Veteran Health Affairs Hospital System between October 2004 and July 2016. Patients with IC/BPS were identified from the Veteran Informatics and Computing Infrastructure (VINCI) system using appropriate ICD codes. Patients older than 18 years of age with a confirmed diagnosis of IC/BPS who underwent cystoscopy were included. Rates of cystoscopic findings of ulceration, glomerulation, inflammation, trabeculation, and tumors adjusted for patient demographics were analyzed. Results A total of 570 patients met inclusion criteria and underwent analysis (57.9% female). The female cohort was of younger age (48.0 vs. 63.0 years). After adjusting for age, men and women had a similar likelihood of presenting with Hunner's lesions (8.2% for men and 3.7% for women, p > 0.05). They also had a similar likelihood of glomerulation (11.4% in men vs. 15.2% in women, p = 0.05) and inflammation (19.6% vs. 15.8%, p > 0.05). Men were significantly more likely to present with trabeculation (15.4% vs. 8.1%, p = 0.03). Urothelial tumors on cystoscopy were rare in both groups. Conclusion The proportion of patients with ulceration on cystoscopy in this study is consistent with previously published studies, and our study showed a similar prevalence of Hunner's lesions between men and women. Cystoscopic identification of Hunner's lesions is an important aspect of IC/BPS management given that treatment directed that these lesions is relatively successful compared to other treatments.