Evaluation of clinical efficacy of pelvic ultrasound monitoring combined with scale scoring in the treatment of interstitial cystitis by intravesical instillation regimen combined with hydrodistention and transurethral fulguration

Background: To evaluate the clinical efficacy of pelvic ultrasound monitoring combined with various scale scores in the treatment of interstitial cystitis with intravesical instillation of heparin/alkalized lidocaine (lidocaine mixed with sodium bicarbonate) combined with hydrodistention and transurethral fulguration. Methods: From June 2016 to June 2023, patients who were diagnosed as interstitial cystitis in urology department of the xuzhou central hospital were selected. All patients received intravesical instillation regimen of 2% lidocaine 10ml + 5% sodium bicarbonate 5ml + heparin 25000IU for 6 months, and they chose whether to receive hydrodistention and transurethral fulguration treatment according to their wishes. Patients were divided into hydrodistention and transurethral fulguration (HD/TF) group and non-HD/TF group. The 24-hour urination frequency, nocturia frequency, pelvic ultrasound measurement results (maximum filling bladder volume, bladder wall thickness after urination, residual urine volume), O'Leary-Sant interstitial cystitis symptom index (ICSI), O'Leary-Sant interstitial cystitis problem index (ICPI), pelvic pain and urgency/frequency (PUF), pain visual analogue score (VAS), self-rating anxiety scale (SAS) were recorded before treatment and 3 and 6 months after treatment. Results: A total of 68 patients were included in this study, including 13 males (19.12%) and 55 females (80.88%), with an average age of 59.07 ± 8.15 years. 68 patients were divided into HD/TF group (n=30) and non-HD/TF group (n=38) according to whether they received hydrodistention and transurethral fulguration. After the 3rd and 6th months of treatment, the 24-hour urination frequency and nocturia frequency in both groups decreased significantly (P<0.05), and the 24-hour urination frequency and nocturia frequency after the 3rd and 6th months of treatment in HD/TF group decreased significantly compared with that in non-HD/TF group (P<0.05). After the 3rd and 6th months of treatment, the maximum filling bladder volume in the two groups increased and the residual urine volume decreased (P<0.05). In addition, the maximum filling bladder volume of the HD/TF group increased significantly compared to the non-HD/TF group after 3rd and 6th months of treatment (P<0.05), while the bladder wall thickness after urination decreased compared to the non-HD/TF group after 3rd months of treatment (P<0.05). There was no significant difference in residual urine volume between HD/TF group and non-HD/TF group before and after treatment (P>0.05). The postoperative scores at 3rd and 6th months of ICPI, ICSI, PUF, SAS and VAS in both groups were significantly lower than those before treatment (P<0.05), and The postoperative scores at 3rd and 6th months of ICPI, ICSI, PUF, SAS and VAS in HD/TF group were significantly lower than those in non-HD/TF group (P<0.05). Conclusions: Intravesical instillation of heparin/alkalized lidocaine combined with hydrodistention and transurethral fulguration is an effective treatment for interstitial cystitis, which can significantly reduce patient pain and improve patient prognosis. Moreover, the use of pelvic ultrasound to monitor indicators such as maximum filling bladder volume and residual urine volume, combined with ICSI, ICPI, PUF, VAS, and SAS scores, has high application value for evaluating the efficacy of intravesical instillation regimen combined with hydrodistention and transurethral fulguration in the treatment of interstitial cystitis.