Therapeutic efficacy of narrow band imaging‐assisted transurethral electrocoagulation for ulcer‐type interstitial cystitis/painful bladder syndrome

Abstract

Objectives Narrow band imaging cystoscopy can increase the visualization and detection of Hunner's lesions. A single‐center, prospective clinical trial was carried out aiming to show the effectiveness of narrow band imaging‐assisted transurethral electrocoagulation for ulcer‐type interstitial cystitis/painful bladder syndrome. Methods A total of 23 patients (19 women and 4 men) diagnosed as having ulcer‐type interstitial cystitis/painful bladder syndrome were included. All typical Hunner's lesions and suspected areas identified by narrow band imaging were electrocoagulated endoscopically after the biopsy of those lesions. Therapeutic efficacy was assessed prospectively by using visual analog scale score of pain, O'Leary–Sant's symptom index, O'Leary–Sant's problem index and overactive bladder symptom score. Results The mean follow‐up period was 22 months. All patients (100%) experienced a substantial improvement in pain. The average visual analog scale pain scores significantly decreased from 7.3 preoperatively to 1.2 1 month postoperatively. A total of 21 patients (91.3%) who reported improvement had at least a 50% reduction in bladder pain, and five reported complete resolution. Daytime frequency was significantly decreased postoperatively. O'Leary–Sant's symptom index, O'Leary–Sant's problem index and overactive bladder symptom score were significantly decreased postoperatively. However, during the follow‐up period, a total of six patients had recurrence, and repeat narrow band imaging‐assisted transurethral electrocoagulation of the recurrent lesions was carried out for five of the six patients, with good response in relieving bladder pain. Conclusions Our results showed that narrow band imaging‐assisted transurethral electrocoagulation could be a valuable therapeutic alternative in patients with ulcer‐type interstitial cystitis/painful bladder syndrome, with good efficacy and reduction of recurrence rate.

Hunner lesion versus non‐Hunner lesion interstitial cystitis/bladder pain syndrome

“…used NBI to identify HL. Twenty‐three patients underwent electrocauterization of a mean of 4.5 HL with significant improvement in VAS for pain, the O'Leary Sant Symptom and Problem Indices, and the overactive bladder symptom score at 22 months follow‐up . Laser ablation of HL was reported by Malloy with recurrence in the short term .…”

“…From a diagnostic as well as therapeutic standpoint, it is important to identify all lesions. NBI may be helpful in identifying HL with greenish bleeding in the HL and red areas around the lesion with angiogenesis . (Fig.…”

“…Cystoscopy with hydrodistention under general/regional anesthesia using a rigid cystoscope is recommended . NBI may be helpful in identifying HLs . Biopsies are taken from areas of mucosal lesions and should include 3 biopsies including the detrusor …”

“…13,29 NBI may be helpful in identifying HLs. 30 Biopsies are taken from areas of mucosal lesions and should include 3 biopsies including the detrusor. 13,29 Histopathology: Inflammatory infiltrate components of HL include: lymphocytes, plasma cells, neutrophil and eosinophil granulocytes, macrophages, MC, and focal, perineural arrangement of the inflammatory cells.…”

Ulcerative interstitial cystitis in an adolescent successfully treated with complete transurethral ulcer resection: A case report

“…Kajiwara et al . reported the efficacy of narrow band imaging‐assisted bladder surgery to precisely detect ulcerative lesions . In our patient, the border between the trigonal ulcer and normal mucosa was relatively clear, and narrow band imaging was not needed.…”