The surgical options for Hunner’s lesions: an update

Abstract

Hunner’s lesions, previously described as Hunner’s ulcers, are a component of bladder pain syndrome (BPS), a condition affecting the lower urinary tract, with symptoms of suprapubic pain related to bladder filling, and associated complaints of urgency and frequency. A diagnosis of BPS requires active exclusion of pathology such as constipation, endometriosis, urinary tract infection, bladder stones and pelvic cancer. Women are predisposed to the condition more than men, in a 4:1 ratio. Survey data indicates 2% of women in the USA suffer from BPS. BPS is both physically and emotionally debilitating. In this review, we look at the place of the Hunner’s lesion in BPS and focus on how a lesion might be treated using the available evidence.

Bladder pain syndrome in men

“…Classical cystoscopic features are a normal bladder initially, small capacity, straining and pain under anaesthesia on filling, and post‐fill glomerulations with or without Hunner's lesions (stellate prominent blood vessels that rupture on filling or contact) (Figure 1). 5 The presence of Hunner's lesions, seen in approximately 10% of patients, can signify BPS that is harder to effectively manage 6 …”

“…Earlier surgical intervention is advised if Hunner's lesions are present, as oral therapies seem less effective 2,5 . Options for managing these include resection, fulguration or ablation, but these can themselves cause postoperative pain, urgency and reduction in bladder capacity.…”

“…There is also a group of patients with BPS and Hunner's lesions who seem to respond poorly to all interventions and develop contracted, highly symptomatic ‘end‐stage’ bladders, and it is possible that recurrent surgical management exacerbates this by creating scarring and reducing bladder compliance and capacity 5 …”

“…There is also a group of patients with BPS and Hunner's lesions who seem to respond poorly to all interventions and develop contracted, highly symptomatic 'end-stage' bladders, and it is possible that recurrent surgical management exacerbates this by creating scarring and reducing bladder compliance and capacity. 5 Intravesical intradetrusor injection of botulinum toxin A can provide short-to medium-term symptom improvement when injected into the trigone. The presence or absence of Hunner's lesions does not appear to influence response to botulinum toxin A injection therapy.…”