Time Until Procedural Intervention in Female Bladder Pain Syndrome at a Tertiary Referral Center in the United States

Female bladder pain syndrome (FBPS) is a chronic condition characterized by bladder pain, urgency, and frequency that significantly impacts quality of life. Management includes nonsurgical and procedural therapies. Our objective was to evaluate the time from FBPS diagnosis to procedural intervention and identify predictors of intervention.

A retrospective cohort study identified women with FBPS from 2013 to 2023 using ICD-10 codes at a single tertiary care center in the United States. Interventions were categorized per the 2022 AUA guideline, including behavioral/non-pharmacologic therapies, medications, intravesical instillations, procedures, and major surgeries. Kaplan-Meier analysis estimated time to first procedural intervention, and Cox proportional hazards models identified factors associated with intervention.

Among 149 patients, 111 (74.5%) underwent at least one bladder-directed procedural intervention, with a median time to first procedure of 1.08 years. The most common intervention was cystoscopy with hydrodistension (N = 83, 55.7%), followed by intravesical instillations (53, 35.6%). Image-guided nerve blocks (11, 7.4%) and onabotulinumtoxinA injections (5, 3.4%) were less frequent. Among those undergoing procedures, 84 (75.7%) required repeat interventions. On multivariable analysis, stress urinary incontinence (HR 2.02, p = 0.05) and tobacco use (HR 1.86, p = 0.03) were associated with increased hazard, while partnered relationship status was associated with reduced hazard (HR 0.62, p = 0.05).

Most patients with FBPS underwent procedural intervention by 1.08 years from diagnosis, most commonly cystoscopy with hydrodistension. Stress urinary incontinence and tobacco use were significant predictors. These findings highlight the importance of individualized management and early identification of patients likely to require procedural therapy.