UroToday- The Interstitial Cystitis Database Cohort Study (ICDB) was an observational, longitudinal cohort of 637 patients with BPS/IC treated by their physicians according to usual clinical care in the absence of protocol specific intervention. All patients had symptoms of urinary urgency, frequency or pelvic pain/discomfort for at least 6 months before study entry. In a previous publication, the ICDB study group from the University of Pennsylvania had reported that the primary symptoms of frequency, urgency and pain were strongly and independently associated with several biopsy features, including loss of urothelium and several findings in the lamina propria, such as mastocytosis, granulation tissue, vascular density, and acute hemorrhage. Leiby and colleagues from the University of Pennsylvania have now reevaluated the pathological data from the ICDB using cluster analysis with a focus on the relatedness of biopsy features to each other and examined the relationship of the resultant groupings to the severity of primary symptoms.

Three morphology clusters were identified, corresponding to unique pathological groupings. Cluster variables included denudation of urothelium and the following findings in the lamina propria: granulation tissue, edema, dense lymphocytosis, and small nerve proliferation. Cluster membership was significantly associated with baseline nighttime and 24-hour frequency and with urinary urgency. Cluster membership was not significantly associated with pain. Significant increases in baseline frequency among clusters persisted throughout the 30 months of follow-up of ICDB patients. Differences among clusters with respect to pain and urgency were not consistent across the follow-up period.

The authors conclude that the use of biopsy data appears to be a powerful parenchyma oriented approach to subgroup assignment, and suggest that future clinical trials stratify patients according to their findings.

Leiby BE, Landis JR, Propert KJ, Tomaszewski JE, Interstitial Cystitis Data Base Study Group
J. Urol. 177(1):142-148, 2007.

Reviewed by UroToday Contributing Editor Philip M. Hanno, MD, MPH

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