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

Int J Urol. 2014 Apr:21 Suppl 1:69-73. doi: 10.1111/iju.12320.

Abstract

Objective: 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.

Keywords: interstitial cystitis; painful bladder syndrome; reconstructive surgical procedure; refractory pain; urinary bladder.

MeSH terms

  • Aged
  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Anti-Bacterial Agents / therapeutic use
  • Cystectomy* / adverse effects
  • Cystectomy* / methods
  • Cystitis, Interstitial* / complications
  • Cystitis, Interstitial* / diagnosis
  • Cystitis, Interstitial* / physiopathology
  • Cystitis, Interstitial* / surgery
  • Female
  • Humans
  • Ileum / surgery*
  • Lower Urinary Tract Symptoms / diagnosis
  • Male
  • Middle Aged
  • Pain, Intractable / etiology
  • Pain, Intractable / surgery
  • Plastic Surgery Procedures / methods
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / therapy
  • Pyelonephritis / diagnosis
  • Pyelonephritis / etiology*
  • Pyelonephritis / therapy
  • Republic of Korea
  • Retrospective Studies
  • Treatment Outcome
  • Ulcer / etiology
  • Ulcer / surgery
  • Urinary Bladder* / pathology
  • Urinary Bladder* / surgery
  • Urinary Catheterization / methods
  • Urinary Diversion* / adverse effects
  • Urinary Diversion* / methods
  • Vesico-Ureteral Reflux / diagnosis
  • Vesico-Ureteral Reflux / etiology*
  • Vesico-Ureteral Reflux / therapy

Substances

  • Anti-Bacterial Agents