A Prospective Observational Study of the Recurrence Characteristics of Hunner Lesion After Repeated Transurethral Ablation in Patients With Interstitial Cystitis/Bladder Pain Syndrome

Abstract

Purpose: The aim of this study was to investigate the rate and pattern of recurrence for patients with Hunner lesion (HL) type interstitial cystitis/bladder pain syndrome (IC/BPS) after transurethral ablation.Methods: This prospective study included 210 patients with HL type IC/BPS. The primary outcomes were the recurrence rate according to 3 patterns of recurrence: pattern A (according to the relationship with the previous surgical site), pattern B (according to the bladder zone), and pattern C (according to the number of lesions). The secondary outcomes were recurrencefree time after treatment according to pattern A and pattern C.Results: The pattern A recurrence rate was 50.8% in the same site (A1), 6.7% at a new site (A2), and 42.5% at mixed sites (A3). The pattern B recurrence rate was 10.5% for the anterior wall, 59.0% for the posterior wall, 69.5% for the lateral wall, and 69.0% for the dome area. Multiple lesions recurred as multiple lesions in 75.8% of cases. The pattern C recurrence rate was 10.8% for C1 (single → single), 6.7% for C2 (single → multiple), 6.7% for C3 (multiple → single), and 75.8% for C4 (multiple → multiple). The recurrence-free time in pattern A was 13 months for A1, 12.5 months for A2, and 8 months for A3, with a significant difference between A1 and A3 (P=0.008). There was no significant difference in recurrence-free time in pattern C, either with single or multiple HLs.Conclusions: The distinct recurrence characteristics of HLs was not predictable despite repeated ablations. Complete remission should not be expected because the whole bladder was to have the potential to develop the HLs even after repeated transurethral ablation.

Interstitiële cystitis, voorbij BPS/IC. Etiologie, epidemiologie en klinische presentatie. Een overzicht vanuit praktijk en literatuur

“…Het effect van ablatie is meestal tijdelijk. De Hunnerse laesies komen terug, soms op dezelfde plek, soms in randen van het litteken en soms ook op ander plekken, en hiermee meestal ook de klachten [32]. IC zelf geeft fibrose en contractuurvorming, maar de herhaaldelijke ablaties ook.…”

Optimal endoscopic treatment and partial cystectomy with or without bladder augmentation for Hunner‐type interstitial cystitis

“…We conducted a similar prospective study involving 210 patients with Hunner lesions to investigate the recurrence patterns of these lesions. 21 Interestingly, our study revealed that recurrence could occur at any location within the bladder wall after repeat ablation, regardless of the site or number of lesions.…”

“…In addition, the study assessed Hunner lesion recurrence following transurethral ablation and revealed that 21.8% of lesions recurred at the previous ablation site, 18.8% at a new site, and 59.4% at both the previous and new sites. We conducted a similar prospective study involving 210 patients with Hunner lesions to investigate the recurrence patterns of these lesions 21 . Interestingly, our study revealed that recurrence could occur at any location within the bladder wall after repeat ablation, regardless of the site or number of lesions.…”

Recurrence after postoperative intravesical instillation therapy in Hunner type interstitial cystitis

“…Notably, these histological changes can be observed in the entire bladder and are not confined to the Hunner lesions 7 . Even when the recurrence pattern was prospectively observed after endoscopic ablation, most recurrences of Hunner lesions occurred in the vicinity of the ablation site, but the rate of recurrence at new sites reaches about 50% 17 . For severe pain caused by Hunner lesions, symptom relief may be maintained for a while by ablation of the Hunner lesions.…”