Cystectomy for patients with Hunner‐type interstitial cystitis at a tertiary referral center in Japan

Abstract

Cystectomy is an ultimate treatment option for patients with end-stage Hunner-type interstitial cystitis (HIC). However, pertinent information regarding this procedure such as optimal candidate selection, surgical procedures, possible complications, and treatment prognosis, is limited owing to its extremely low prevalence. We report outcomes of 17 cystectomies for end-stage HIC patients at a tertiary referral center in Japan over a period of 20 years, including partial cystectomy with augmentation ileocystoplasty (PC-CP, 4) and total cystectomy with ileal conduit (TC-IC, 13). Postoperative events including changes in symptoms and quality of life (QOL), related complications, and overall satisfaction were examined. Pain persisted in three PC-CP patients while completely resolved in all TC-IC patients. QOL improved signi cantly in TC-IC but not in PC-CP patients. Two PC-CP patients required clean intermittent catheterization due to voiding dysfunction. Two TC-IC patients developed stricture of ureteroileal anastomosis, resulting in permanent placement of a ureteral stent or nephrostomy. Satisfaction rate was signi cantly higher in TC-IC than in PC-CP patients (76.9% vs 25.0%, p<0.05). Despite the limited number of cases, this study demonstrates that TC-IC provides highly reliable pain relief and improves QOL in end-stage HIC patients. ¶ Classi ed using the Society for Fetal Urology ultrasound grading system of hydronephrosis (ref. 19).

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

“…In patients who underwent total cystectomy, complications arising from ureteroileal anastomotic stricture were observed in two cases, which were managed using ureteral stent placement and nephrostomy. 46 In contrast, several studies, including ours, have indicated that subtotal cystectomy provides substantial symptom improvement and yields more favorable functional outcomes than total cystectomy. In our aforementioned study involving 40 patients with Hunner-type IC who underwent supratrigonal cystectomy with ileocystoplasty, we noted significant enhancements in frequency and nocturia, pain levels measured using the pain VAS, and improvements in ICSI and ICPI when comparing measurements taken before and after surgery.…”

“…Several studies have reported significant symptom improvements after total cystectomy. 45,46 Peters et al found that of eight patients who underwent total cystectomy with an ileal conduit for Hunner-type IC, complete resolution of pain was observed in seven. Although four (50%) patients required reoperation, such as urostomy revision, six patients reported a "marked improvement" in their postoperative QoL.…”

“…The necessity for total cystectomy during reconstructive surgery in patients with IC/BPS is a subject of ongoing debate. Several studies have reported significant symptom improvements after total cystectomy 45,46 . Peters et al found that of eight patients who underwent total cystectomy with an ileal conduit for Hunner‐type IC, complete resolution of pain was observed in seven.…”

“…In contrast, they reported that of the four patients who underwent partial cystectomy with ileocystoplasty, three reported recurrent pain. In patients who underwent total cystectomy, complications arising from ureteroileal anastomotic stricture were observed in two cases, which were managed using ureteral stent placement and nephrostomy 46 …”

Female pelvic organ‐preserving robot‐assisted simple cystectomy and intracorporeal ileal neobladder reconstruction on a young woman with Hunner‐type interstitial cystitis

“… 4 However, to date, optimal patient selection and standardized surgical procedures have not been established. 5 Here we describe the first case of a young woman with HIC who underwent pelvic organ‐preserving robot‐assisted simple cystectomy and intracorporeal ileal neobladder reconstruction.…”