Time to Procedural Intervention in Patients With Interstitial Cystitis and Bladder Pain Syndrome

INTRODUCTION: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition that significantly affects patients' quality of life and psychosocial functioning characterized by bladder pain, urinary frequency, and urgency. IC/BPS is typically diagnosed through detailed history, physical examination, and exclusion of other conditions, with guidelines agreeing that it is a diagnosis of exclusion requiring pain, pressure, or discomfort alongside at least one urinary symptom. The American Urological Association (AUA) identifies subgroups of IC/BPS-bladder-centric, pelvic-floor, and widespread pain phenotypes, guiding treatment based on pathophysiology and presentation. Treatment options are stepwise, from behavioral interventions to major surgery. Despite these options, many patients experience delays in diagnosis and intervention. While studies have examined treatment efficacy, few focus on time to procedural intervention. Understanding these delays is crucial to optimizing management and improving outcomes. OBJECTIVE: This study aims to assess the time from diagnosis of IC/BPS to procedural intervention in IC/BPS patients and categorize interventions according to the AUA 2022 treatment algorithm. METHODS: A retrospective cohort study was conducted using International Classification of Diseases, 10th revision (ICD-10) codes to identify IC/BPS patients diagnosed between 2013 and 2023. Procedures were categorized according to the AUA 2022 treatment algorithm with 3rd line including intravesical instillations, 4th line including cystoscopy with hydrodistension, onabotulinumtoxin-A (BTX-A) detrusor injections, or neuromodulation. Demographics, diagnosis date, procedural interventions, and follow-up outcomes were collected by chart review. Kaplan-Meier survival analysis was used to estimate time to procedural intervention, with “at risk” subjects defined as those who had not undergone a procedure. Median time to first procedure and survival plots were generated with “at risk” numbers displayed at 10-year intervals (Figure 1). RESULTS: A sample size of 150 (N=150) was analyzed, of which 111 (74%) patients had procedural intervention. The cohort was predominantly White (92.4%) with mean age at diagnosis of 34.8 years and at first procedural intervention of 37.5 years. Median time to first procedural intervention of 141 days. Intravesical instillation was performed first in 23.42% and a 4th-line intervention performed in 76.58% of the cohort. Of those who underwent a 4th-line intervention as their first procedure, 97% underwent a cystoscopy with hydrodistension. Of those who underwent cystoscopy with hydrodistension as their first procedure, 68.42% went on to have repeat cystoscopies with hydrodistension, 10.53% went on to undergo BTX-A injections, and 15.79% went on to undergo sacral neuromodulation. 84% of the cohort had repeat procedures after their initial procedural intervention, 54.76% of which were another 4th-line intervention. 65.22% of the 4th-line interventions, after their initial intervention, were cystoscopy with hydrodistension. CONCLUSIONS: Patients with IC/BPS have a median period of only 141 days from time of diagnosis until their first procedural intervention. The majority of patients undergo 4 th-line interventions, of which cystoscopy with hydrodistension is most frequently performed and repeated. Performance of intravesical instillations as first procedure was low. Further studies are needed to assess factors influencing choice of procedural intervention.