Anesthetic Bladder Hydrodistention Is Superior to Superior Hypogastric Plexus Neurolysis in Treatment of Interstitial Cystitis–bladder Pain Syndrome: A Prospective Randomized Trial

Abstract

To evaluate efficacy and safety of superior hypogastric plexus neurolysis (SHN) for treatment of interstitial cystitis (IC)-bladder pain syndrome (BPS) in comparison with bladder hydrodistention (HD). In a prospective study, 24 female patients were randomly allocated to receive either SHN or HD. Patients were evaluated by recording the O'Leary-Sant IC symptom indices, IC problem indices, pain visual analog scale (VAS), number of daytime frequency, and nocturia. Pressure flow study was conducted for all patients. Intraoperative and postoperative changes and adverse events were recorded. Basal IC symptom indices, IC problem indices, and VAS scores were comparable between both groups (P = .31, .63, and .94, respectively). There was no statistically significant difference between both groups with respect to urodynamic parameters. Only pain VAS at first week was improved in SHN in comparison with HD (P = .012). Thereafter, all parameters were significantly improved in favor of the HD group at 2- and 4-week visits. Adverse events in both groups were ranked as Grade 1 Clavien-Dindo classification including transient hematuria in the HD group and transient back ache in the SHN group. Despite effective pain control in cases with IC-BPS after SHN, it lacks durability. It seems that SHN in its current form is not to be a suitable line of treatment for IC-BPS. Multimodality treatment would be needed for proper control of patients' symptoms.