Abstract
To evaluate the outcomes of partial and total cystectomy in patients with refractory Hunner-type interstitial cystitis (HIC). Patients with end-stage HIC who underwent supratrigonal partial cystectomy with augmentation ileocystoplasty (PC-CP) or total cystectomy with ileal conduit (TC-IC) were identified retrospectively. Changes in the 11-point numerical rating scale of bladder pain and in 7-grade quality of life (QOL) scores were evaluated. Changes in the O'Leary and Sant's Symptom Index (OSSI) and O'Leary and Sant's Problem Index (OSPI) were analyzed in patients with PC-CP. Peri- and postoperative complications and patient satisfaction with overall outcomes were examined. Four patients (one female) underwent PC-CP and 13 (nine females) underwent TC-IC. Bladder pain persisted in three PC-CP patients, but resolved completely in all TC-IC patients. Pain scale and QOL scores improved significantly in patients with TC-IC (P < .01), but not in those with PC-CP. OSSI/OSPI scores did not improve significantly in patients with PC-CP. Three PC-CP patients required clean intermittent catheterization due to voiding dysfunction or persistent pain. Two TC-IC patients developed stricture of the ureteroileal anastomosis, resulting in permanent placement of a ureteral stent in one case and nephrostomy in the other. Satisfaction rate was higher in the TC-IC than in the PC-CP group (76.9% vs 25.0%, P < .05). TC-IC provided reliable pain relief and improved QOL in patients with end-stage HIC, but the small case number and limited methodology restrict interpretation of the results. Further studies are needed to identify appropriate candidates and optimal surgical procedures.
Highlights
Hunner-type interstitial cystitis (HIC) is a chronic inflammatory disease of the urinary bladder of unknown etiology, clinically characterized by persistent pelvic pain and lower urinary tract symptoms such as urinary frequency and urgency. 1 The progressive nature of this disease in some patients can result in severe bladder contraction, leading to incredibly increased urinary frequency and/or urinary leakage
O’Leary and Sant’s Symptom (OSSI) and Problem (OSPI) scores, pain intensity, quality of life (QOL) scores, daytime frequency, nocturia, maximum voided volume (MVV) on the frequency volume chart, maximum bladder capacity (MBC) at the last hydrodistension, and the total number of previous sessions of Hunner lesion electrocautery were comparable in these two groups
The present study reports outcomes in 17 consecutive patients who underwent cystectomy for end-stage HIC at a tertiary referral center for interstitial cystitis/bladder pain syndrome (IC/BPS) in Japan
Summary
Hunner-type interstitial cystitis (HIC) is a chronic inflammatory disease of the urinary bladder of unknown etiology, clinically characterized by persistent pelvic pain and lower urinary tract symptoms such as urinary frequency and urgency. 1 The progressive nature of this disease in some patients can result in severe bladder contraction, leading to incredibly increased urinary frequency and/or urinary leakage. Hunner-type interstitial cystitis (HIC) is a chronic inflammatory disease of the urinary bladder of unknown etiology, clinically characterized by persistent pelvic pain and lower urinary tract symptoms such as urinary frequency and urgency. 1 The progressive nature of this disease in some patients can result in severe bladder contraction, leading to incredibly increased urinary frequency and/or urinary leakage. Cystectomy may be the ultimate treatment for patients with end-stage HIC, as described in clinical guidelines for patients with interstitial cystitis/bladder pain syndrome (IC/BPS). 1 2 3 Because this procedure is rarely performed, detailed information on cystectomy, such as candidate selection, surgical procedures, possible complications, and treatment prognosis, is limited. The present study describes our 20 years’ experience with 17 patients who underwent subtrigonal partial cystectomy with augmentation ileocystoplasty (PC–CP) or total cystectomy with ileal conduit (TC–IC) for end-stage HIC
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