Efficacy and safety of augmentation ileocystoplasty combined with supratrigonal cystectomy for the treatment of refractory bladder pain syndrome/interstitial cystitis with Hunner's lesion

Abstract

Abbreviations & AcronymsObjective: To evaluate the efficacy and safety of augmentation ileocystoplasty with supratrigonal cystectomy for the treatment of refractory bladder pain syndrome/interstitial cystitis patients with Hunner's lesion. Methods: Of 45 patients who underwent augmentation ileocystoplasty with supratrigonal cystectomy between July 2006 and June 2012, 40 patients (33 women, 7 men) were included in the analysis. Primary outcome was the change in the O'Leary-Sant interstitial cystitis symptoms/problem index from baseline to 1, 3 and 6 months. Changes in pain, urgency, frequency, functional bladder capacity and maximal cystometric capacity were also assessed. Intraoperative and postoperative complications were evaluated. Results: Median preoperative symptom duration was 5.0 years (range 3.0-6.0 years). Pain decreased significantly after surgery (8.3 vs 1.3, P < 0.001). Functional bladder capacity and maximal cystometric capacity increased, whereas frequency, urgency and nocturia decreased significantly after surgery (all P < 0.001). At 6 months, significant improvements in the interstitial cystitis symptom index (17.8 vs 9.9, P < 0.001) and interstitial cystitis problem index (14.6 vs 6.5, P < 0.001) compared with baseline were noted. Seven patients developed vesicoureteral reflux and seven patients had acute pyelonephritis that resolved with antibiotic treatment. Five patients required clean intermittent self-catheterization. None of the preoperative factors were significant predictors of treatment failure. Conclusions: Augmentation ileocystoplasty with supratrigonal cystecomy decreased pain and frequency, and increased bladder capacity significantly. There were no severe complications related to surgery during follow up. Augmentation ileocystoplasty with supratrigonal cystectomy is therefore an appropriate final treatment strategy for refractory bladder pain syndrome/interstitial cystitis patients with Hunner's lesion.

Clinical guidelines for interstitial cystitis and hypersensitive bladder updated in 2015

“…Partial or complete cystectomy and bladder augmentation with or without urinary diversion would be the last resort for intractable cases, who are resistant to the aforementioned therapies and still highly symptomatic. Supratrigonal cystectomy with subsequent bladder augmentation using a bowel segment is the most common continence‐preserving technique . Subtrigonal cystectomy with ureteral reimplantation or total cystectomy with urinary diversion is an alternative option.…”

“…Subtrigonal cystectomy with ureteral reimplantation or total cystectomy with urinary diversion is an alternative option. Pelvic pain is usually relieved, but occasionally persists after augmentation and cystectomy . Intermittent catheterization might be required after neobladder formation.…”

“…Supratrigonal cystectomy with subsequent bladder augmentation using a bowel segment is the most common continence-preserving technique. 92 Subtrigonal cystectomy with ureteral reimplantation or total cystectomy with urinary diversion is an alternative option. Pelvic pain is usually relieved, but occasionally persists after augmentation and cystectomy.…”

How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI‐RS 2018

“…Complications appeared to be worse in group 1. A recent larger study assessed 40 patients with Hunner's lesions who underwent augmentation ileocystoplasty with supratrigonal cystectomy . In this series, there was a significant improvement in storage lower urinary tract symptoms, cystometric capacity, VAS pain scores, and O'Leary‐Sant questionnaire scores but the persistence of symptoms occurred in 20%.…”

Management of Bladder Pain Syndrome

“…72 Urinary diversion in the form of an ileal conduit (with or without simple cystectomy) will not require intermittent self-catheterisation. 87 This surgery is usually performed in specialist centres by a urologist.…”