The Treatment of Interstitial Cystitis by Cystolysis with Observations on Cystoplasty. A Review after 7 Years.

Abstract

In our original paper we discussed the place of cystolysis in the management of interstitial cystitis when the bladder had a capacity of at least 400 ml under general anaesthesia (Worth and Turner-Warwick, 1973).I have continued to use this technique, obtaining good symptomatic improvement in the majority of patients. I have tried extending its use in, for example, the patient with a sensitive and painful bladder whose type of chronic cystitis differs histologically from interstitial cystitis. This group has included 2 men. I have also used the technique in patients with severe frequency and a cystoscopically normal bladder (usually with an above average capacity) and who also have an incontinence problem. Although it is relatively easy to combine this technique with a suprapubic repair procedure, the results are unsatisfactory because the denervation cannot really affect the trigone.I think it is fair to say that in urological practice the type of patient who might benefit from the operation is seen infrequently. It is likely that such patients have already had a considerable number of different medications (often including steroids), usually administered systemically rather than intravesically.These patients are very symptomatic, with pain and frequency. When drug treatment has failed, the alternatives to cystolysis are either cystoplasty or diversion. The technique of cystolysis has not altered and remains relatively simple; morbidity is low and the procedure does not compromise any subsequent surgery. The results remain unpredictable in the long term, but in the short term pain becomes negligible and as a result frequency is much reduced.If symptoms return post-operatively, further cystoscopy should be undertaken. It is always possible that the bladder capacity has diminished and this may occur because the blood supply to the dome has been too severely compromised -hence care should be taken during operation to preserve at least one superior vesical artery.As the next procedure I would recommend cystoplasty (preferably caecocystoplasty) rather than diversion, since cystoplasty in interstitial cystitis gives excellent results. ReferenceWorth, P. H. L. and Turner-Warwick, R. (1973). The treatment of interstitial cystitis by cystolysis with observations on cystoplasty. British Journal of Urology, 45, 65-71. 232

Colocystoplasty for the Treatment of Severe Interstitial Cystitis

“…The subjective results of colocystoplasty were highly satisfactory compared with the situation before the oper ation, all the patients except one having complete elimi nation of pain and remarkably increased interval be tween the voidings, which agrees with previous reports [5,19,24,25], In the unsuccessful case an inflammatory reaction in the trigone due to interstitial cystitis was found, on the lines of that reported by Seddon et al [ 19], so that total cystectomy and urinary diversion was re garded as the only possibility. One other case who became incontinent after bladder neck incision having had constantly persisting infection and therefore re quired urinary diversion 2 years after the colocystoplasty may also be regarded as a failure.…”

“…Three of our patients also suffered from reflux postoperatively, and one of them later developed a stenosis of the distal ureter. The reason may be overextensive resection of bladder tissue around each ureter [25] or high-pressure contractions of the bowel, or most probably both of these effects together. The reflux did not appear to have produced any signifi cant renal deterioration during the mean follow-up inter val of 4.7 years but careful follow-up and treatment or urinary infections may still be regarded as being of the utmost importance, including long-term antibiotic ther apy if necessary.…”

Coecocystoplasty: An Evaluation of Operative Results

“…The spontaneous bowel contractions along with a decrease in urethral pressure during sleep [1] frequently give rise to nocturnal incontinence [6], There is no agreement as to which segment of the bowel should be preferred when performing an enterocystoplasty. The literature is conflicting and does not solve the problem [11][12][13]. We find a coecocystoplasty accept able because of the relatively easy surgery, good blood supply for the anastomosis and simplicity in deciding the length of the intestinal segment [11].…”

Surgical management for overactive bladder

“…However, these results were not reproduced in other studies that followed. Worth [14] reported that of 10 patients who underwent cystolysis, only three patients were cured, and the other seven had partial or no improvement. A 7-year follow-up showed that the three patients who were cured had no further symptoms [14].…”