Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic syndrome of unknown etiology characterized by urgency, frequency and bladder pain without effective definite treatment. Patients always have moderate anxiety mood status. Physical and psychological status and treatment outcome are closely related. Anxiety is also the predecessor of depression. This study investigated the impact of anxiety severity on therapeutic results of IC/BPS patients.

Seventy-five IC/BPS patients (68 female and 7 male) who received any kind of treatment were prospectively enrolled. The primary endpoint was changes of Beck’s Anxiety Inventory (BAI) for anxiety mood before and 3 months after treatment. Secondary endpoints included the changes of Global Response Assessment (GRA), O'Leary-Sant score (OSS), and Visual Analog Scale (VAS). The clinical symptom scores were also compared with cystometric bladder capacity (CBC) under the urodynamic study.

All patients completed the study. The patients were divided into three groups according to their anxiety severity based on BAI: (1) 0-15 point (N=29, mean age, 52.3±13.3 years), (2) 16-25 point (N=19, mean age, 49.9±13.9 years), and (3) 26-63 point (N=27, mean age, 57.4±9.9 years, p= 0.113). The mean duration of IC symptoms was 97±75.2 months. Cystoscopic hydrodistention was performed in all patients, with a mean maximal bladder capacity (MBC) of 691±176 ml, and a mean glomerulation grade of 1.65±0.79. There was no significant difference of symptom duration, MBC and glomerulations among patient groups of different BAI severity. After treatment, the mean BAI decreased from 37.6±7.6 to 22.1±10.4 at 3 months in patients with severe anxiety score (P< 0.001). Patients with mild anxiety score did not show significant change in BAI after treatment. However, the improvement of ICSI, ICPI, VAS and GRA all showed significance after treatment in three groups, and there was no significant difference between groups. After treatment, Qmax improved only in BAI 0-15 points group (Table1). The changes of BAI after treatment was significantly associated with the changes of ICSI (r= 0.288), ICPI (r= 0.350), VAS (r= 0.300), and GRA (r= 0.347). The changes of BAI was associated with change of ICPI (r= 0.607), ICSI (r= 0.524) and VAS (r= 0.292). Among overall patients, 38(51%) had a GRA ≥2 after treatment. The BAI showed significantly improved in the patients with GRA≥2 (baseline, 23.7±13.2; 3M, 14.9±8.7, p< 0.01) but was not in patients with a GRA <2 (baseline, 21.8±12.5; 3M, 20.0±9.6, p= 0.01). We also found the change of VAS (baseline, 5.1±2.9; 3M, 1.8±2.0, p< 0.001), BAI (baseline, 22.0±14.1; 3M, 14.2±7.5, p= 0.05) and GRA (3M, 2.0±0.9, p< 0.001 ) significantly improved in the patients with change of OSS ≥7 points. Ultimately, when we predict the factors which affect the GRA by multiple linear regression, only OSS was significantly associated (β＝-.59, p < 0.05). Anxiety score, age, duration and VAS did not have significant association with the GRA after treatment (Table 2).

The results of this study suggest baseline BAI does not influence treatment outcome of IC/BPS. Regardless of the level of anxiety, IC/BPS patients had significant improvement in ICSI, ICPI, VAS, and GRA. The change of BAI was significantly greater in patients with a GRA ≥2. The improvement of GRA was mainly due to decrease of symptoms and problems of the bladder.

The improvement in physical and visceral distress symptoms of BAI is significantly associated with an increase of GRA after treatment, indicating that IC/BPS patients should be advised to receive regular and persistent treatment to achieve a better therapeutic outcome.