Interstitial cystitis and adenomyosis frequently coexist in chronic pelvic pain syndrome

OB/GYN News, Nov 15, 2004 by Miriam E. Tucker

NEW YORK -- Interstitial cystitis often coexists with adenomyosis, just as it does with endometriosis, Stephen A. Grochmal, M.D., said at an international congress of the Society of Laparoendoscopic Surgeons.

"How many patients do we have who continue to have pain after endometrial ablation or after hysterectomy? Before we send them to a psychiatrist, perhaps we ought to give them a 5-minute screening questionnaire to see if they have associated interstitial cystitis," Dr. Grochmal of the division of operative gynecology, endoscopy, and laser surgery at Howard University. Washington.

If the patient's score on that questionnaire--the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale--suggests interstitial cystitis (IC), then diagnostic tests are indicated (Urology 2002;60:573-8).

In 2002, Maurice K. Chung, M.D., and his associates described the "evil twins" of endometriosis and IC in chronic pelvic pain syndrome. They found a 70% overlap of the two conditions among 60 women (JSLS 2002;6:311-4).

"After I read that, I considered that we might see the same thing with adenomyosis. After all, it is endometriosis of the myometrium," Dr. Grochmal explained.

So he retrospectively analyzed 287 women who were part of an ongoing study that compared the long-term effect on amenorrhea rates of endometrial resection by Nd:YAG laser versus resectoscope. Despite alleviation of their uterine bleeding, 60% (172) of the women reported postoperative chronic pelvic pain, along with urinary urgency and frequency, dysuria, rectal pain, perineal pain, dysmenorrhea, decreased sexual intimacy, and decreased quality of life.

Following a review of their surgical pathology reports and examination of uterine shavings or laser-excised tissue strips to exclude subbasalis diagnoses, "pure" adenomyosis was confirmed in 48 (28%) of the 172 women. Of those 48, 32 (67%) had a score greater than 6 out of a total of 35 on the PUF scale, suggesting IC. Of those 32, 27 (84%) had positive potassium sensitivity test scores.

With use of established criteria for cystoscopy/hydrodistention, IC was confirmed in 25 (78%) of the 32 women, and in 1 (6%) of the 16 women with PUF scores less than 6.

Among the remaining 124 chronic pelvic pain patients who did not have adenomyosis, 54 were randomly selected for the same testing. Of those, six (11%) also had confirmed IC, in contrast to the total 60% of those with adenomyosis.

In patients who have chronic pelvic pain after the treatment of excessive uterine bleeding, adenomyosis may be the cause of the bleeding and the bladder may the cause of the chronic pelvic pain, Dr. Grochmal speculated at the meeting.

BY MIRIAM E. TUCKER

Senior Writer