Fulguration for Hunner Ulcers: Long-Term Clinical Outcomes

Hillelsohn, Joel; Rais‐Bahrami, Soroush; Friedlander, Justin I.; Okhunov, Zhamshid; Kashan, Mahyar; Rosen, Lisa; Moldwin, Robert

doi:10.1016/j.juro.2012.08.013

Cited by 72 publications

(65 citation statements)

References 10 publications

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“…This retreatment rate is lower than the rates reported by other fulguration studies [16,17]. This may be because 1) the follow-up period of our study was shorter than those of the previous studies, and 2) when symptoms recurred after the first fulguration, we treated them with intravesical instillation; repeat fulguration was applied only if the patient still did not show symptom improvement.…”

Section: Discussioncontrasting

confidence: 58%

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468 Elimination of Hunner's ulcers by fulguration in patients with interstitial cystitis: Is it effective and long lasting?

Song¹,

Chun²,

Park³

et al. 2014

European Urology Supplements

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Purpose:To evaluate the outcome of fulguration of Hunner's ulcers (HUs) in painful bladder syndrome/interstitial cystitis (PBS/IC) that is refractory to conservative treatment. Materials and Methods: Patients diagnosed with refractory PBS/IC and treated with fulguration between 2011 and 2013 were identified through screening of medical records. To evaluate treatment outcomes, voiding diaries, the visual analogue scale (VAS) for pain, and two IC symptom questionnaires (pelvic pain and urgency/frequency scale [PUF] and O'Leary-Sant IC symptom index and IC problem index [OS]) were used. Fulguration was deemed to be successful if the VAS score was ＜2 or less than half of the preoperative VAS score. Results: In total, 27 patients with PBS/IC in whom conservative treatments had failed were enrolled. Two months after fulguration, decreases were observed in the mean 24-hour urinary frequency (from 16.0 to 10.2), 24-hour urgency episodes (8.0 to 1.8), and the VAS (5.8 to 1.2), PUF symptom (15.1 to 7.0), PUF bother (8.4 to 2.7), OS symptom (15.1 to 7.2), and OS problem (13.8 to 6.0) scores. At 5 and 10 months, all variables had worsened. At 2, 5, and 10 months, the success rates were 94.1%, 70.0%, and 33.3%, respectively. Four patients underwent one repeat fulguration on average 11.3 months after the first fulguration. Repeat fulguration was not significantly associated with any clinical characteristics. Conclusions: In PBS/IC that was refractory to medication or other conservative treatments, HU elimination by fulguration effectively improved symptoms. However, this effect decreased gradually over time.

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Section: Discussioncontrasting

confidence: 58%

“…Hillelsohn et al [17] reported the long-term clinical outcomes of 59 patients with HUs who were treated by electrocautery by using the Bugbee electrode. Of the 32 patients who underwent a single fulguration, 25 (78%) reported improved or stable symptoms.…”

Section: Discussionmentioning

confidence: 99%

468 Elimination of Hunner's ulcers by fulguration in patients with interstitial cystitis: Is it effective and long lasting?

Song¹,

Chun²,

Park³

et al. 2014

European Urology Supplements

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“…169 Fulguration with a Bugbee electrode is another option that led to symptomatic improvement in 76-90% of 150 cases described. [170][171][172][173] Transurethral coagulation using neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, has been reported in two small observational series with short-term improvements of 78% and 100%. 174,175 To prevent bladder or bowel perforation, low bladder filling volume and low-power setting (10-15 W), firing during 1-3 seconds in constant motion until the ulcer is blanched, are recommended.…”

Section: Treatment Of Hunner's Lesions (Recommended For Patients Withmentioning

confidence: 99%

CUA guideline: Diagnosis and treatment of interstitial cystitis/ bladder pain syndrome

Cox

Golda

Nadeau

et al. 2016

CUAJ

111

121

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MethodologyThe following guidelines were based on MEDLINE and PUBMED searches of English language literature, in addition to consensus conference proceedings. Levels of evidence and grades of recommendation were assigned for each investigation and treatment, as per the modified Oxford Centre for Evidence-Based Medicine grading system. Where the literature was inconsistent or scarce, a consensus expert opinion was generated to provide treatment guidelines.

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“…12,13 However, these measures produce only temporary symptom relief in most cases. Progressive deterioration of symptoms refractory to conservative treatment eventually leads to major reconstructive surgery.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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Fulguration for Hunner Ulcers: Long-Term Clinical Outcomes

Cited by 72 publications

References 10 publications

468 Elimination of Hunner's ulcers by fulguration in patients with interstitial cystitis: Is it effective and long lasting?

468 Elimination of Hunner's ulcers by fulguration in patients with interstitial cystitis: Is it effective and long lasting?

CUA guideline: Diagnosis and treatment of interstitial cystitis/ bladder pain syndrome

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

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