ICS 2022 Abstract #388 Impact of urinary tract infections on patients with IC/BPS or IC with Hunner lesions. (2024)

Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as a chronic discomfort/pain attributed to the urinary bladder for more than 6 months accompanied by urgency and/or frequency. Some patients additionally have Hunner lesions in the bladder (IC with Hunner lesions).[1] Both IC/BPS and IC with Hunner lesions will hereafter be referred to as IC/BPS. IC/BPS is a symptom-based diagnosis, other identifiable diseases have to be excluded. 1500-4000 patients receive treatment for IC/BPS in the Netherlands. The disruption of the urothelial barrier is a main feature of IC/BPS and may also make these patients more at risk for UTI’s. [2] Clinically recurrent urinary tract infections (rUTI), defined as ≥2 UTIs per 6 months or ≥3 UTI per year, are common in patients with IC/BPS. UTIs in patients with IC/BPS are likely to negatively impact pre-existing symptoms and cause flare-ups. Nonetheless, there is little attention given to UTI presence, burden and management in literature and guidelines. We aim to clarify the presence and burden UTIs have on IC/BPS patients in an attempt to improve healthcare management of IC/BPS patients.

We performed a retrospective survey study. A patient survey was conducted through the Dutch IC/BPS patient association (ICP) to evaluate symptoms and QoL in IC/BPS patients (members and non-members). The survey contained a section related to the presence of UTIs, antibiotics use and impact of UTI’s on IC/BPS symptoms and diagnosis. Patients with Hunner lesions and patients without Hunner lesions were analyzed as one group.

A total of 217 patients filled out the survey. 95% of patients received the diagnosis of IC/BPS after cystoscopy. 68% of patients reported that their general practitioner had confused their IC/BPS symptoms with recurrent UTIs in the past (table 1). This gave a delay in diagnosis of IC/BPS of 2 or more years in 66% of patients, 26% had a delay of 6 years or more. 21% of patients reported regularly having UTIs, additionally 33% reported having had regular UTIs in the past. Of these patients, 70% received antibiotics in the last two years, 23% received 6 or more antibiotic treatments. 50% has received prophylactic antibiotic therapy and 32% reported antibiotic resistance in urine cultures. Fear of a new UTI was reported by 68%. 58% reported severe worsening of their IC/BPS symptoms after a UTI. Moreover, 33% of all IC/BPS patients reported a large increase in healthcare consumption for their IC/BPS symptoms during or after a UTI.

In this study 95% of patients were diagnosed with IC/BPS using a cystoscopy. This is in line with the current EAU guideline, making the study population well defined. More than 50% of IC/BPS patients reported regular UTIs now or in the past. UTIs resulted in frequent antibiotics use and even antibiotic resistance. Moreover UTIs lead to severe worsening of IC/BPS symptoms in more than half the patients, causing many IC/BPS patients to seek more medical help. More than two thirds of the patients with frequent infections end up fearing a new UTI.This survey was filled-out by patients how are treated in the Dutch healthcare system using Dutch guidelines. The results might differ for patients in other healthcare systems where screening and treatment for UTIs is done using different guidelines. Moreover, it is possible that the results are influenced by non-response bias, patients with few or mild symptoms are less inclined to participate in a survey study than patients with severe symptoms. Therefor the presence and impact of UTIs might be overestimated in this study.Nonetheless , these results clearly show a large burden imposed by UTIs on the IC/BPS patient population.

UTIs are a frequent occurrence in IC/BPS patients, causing severe worsening of symptoms in more than half of the patients. This can lead to increased healthcare consumption and patients fearing new infections, placing a burden on individual patients and the healthcare system. Our results show a clear need for better prevention management and treatment of rUTIs in patients with IC/BPS and guidelines should incorporate UTI management advise in their recommendations.

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Parsons, C.L., The role of the urinary epithelium in the pathogenesis of interstitial cystitis/prostatitis/urethritis. Urology, 2007. 69(4 Suppl): p. 9-16.