E2 ModerateModerate confidencePEM not requiredCase-ControlPeer-reviewedReviewed
Association of bladder pain syndrome/interstitial cystitis with urinary calculus: a nationwide population-based study.
Keller, Joseph, Chen, Yi-Kuang, Lin, Herng-Ching · International urogynecology journal · 2013 · DOI
Quick Summary
This study looked at whether people with bladder pain syndrome/interstitial cystitis (BPS/IC) are more likely to have had kidney stones or other urinary stones. Researchers compared about 9,000 people newly diagnosed with BPS/IC to over 46,000 similar people without BPS/IC and found that those with BPS/IC were significantly more likely to have a history of urinary stones, particularly bladder stones.
Why It Matters
ME/CFS patients frequently experience overlapping conditions including pain syndromes and urological dysfunction. Understanding associations between BPS/IC and urinary calculi may help clinicians recognize clusters of related symptoms and provide more comprehensive care for this complex patient population, while also suggesting shared pathophysiological mechanisms that warrant investigation.
Observed Findings
- Prior urinary calculus was significantly more prevalent in BPS/IC cases than controls (8.1% vs 4.3%, p<0.001).
- Bladder stones showed the strongest association with BPS/IC (OR=3.80), compared to kidney (OR=1.58), ureter (OR=1.73), and unspecified stones (OR=1.83).
- The association between BPS/IC and prior UC remained significant across all stone types examined.
- The elevated odds persisted after adjustment for 11 comorbid conditions including chronic fatigue syndrome and fibromyalgia.
Inferred Conclusions
- Urinary calculi are more common in patients with BPS/IC than in the general population, suggesting a potential shared pathophysiological mechanism.
- The particularly strong association with bladder calculi may indicate a specific relationship with lower urinary tract pathology.
- The association cannot be explained by common comorbidities, suggesting an independent relationship between these conditions.
Remaining Questions
- What is the temporal relationship—do urinary stones develop before BPS/IC symptoms, after them, or concurrently?
- What biological mechanisms might explain the association between urinary calculus formation and bladder pain syndrome?
- Does the association differ by demographic factors such as sex, age, or ethnicity?
What This Study Does Not Prove
This study demonstrates correlation, not causation—it does not establish whether urinary stones cause BPS/IC, BPS/IC causes stones, or both conditions share an underlying cause. The cross-sectional design cannot determine which condition developed first, and reliance on diagnostic coding may miss cases not formally documented in medical records.
Tags
Symptom:Pain
Method Flag:Mixed CohortWeak Case Definition
Metadata
- DOI
- 10.1007/s00192-012-1917-6
- PMID
- 22895546
- Review status
- Editor reviewed
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 12 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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