Abstract
Introduction
Interstitial cystitis is a debilitating condition that has a profound effect on quality of life. Although many approaches to treatment have been explored, no consistently effective treatment has been identified. Reconstructive surgery is offered to patients with refractory IC/BPS; however, expert opinion is divided as to whether simultaneous cystectomy is necessary to achieve symptomatic cure. The aim of this study was to report our experience in the surgical management of IC/BPS in a university teaching hospital.
Methods
The hospital inpatient enquiry (HIPE) system was used to identify patients with IC/BPS who underwent surgery between 1997 and 2013. Medical records were examined and patients were invited to complete three symptom-based questionnaires.
Results
Twelve patients were identified (8 female, 4 male). Reconstructive procedures included urinary diversion without cystectomy (9) and augmentation ileocystoplasty (4). One patient failed to have a sustained improvement in symptoms following ileocystoplasty and later underwent successful urinary diversion. All other patients noted a “marked improvement” in overall symptoms on global response assessment (GRA) and the resolution of bladder pain on a visual analogue sale (VAS). There were no persistent symptoms or complications related to the retained bladder following diversion.
Conclusion
Our study adds to the existing evidence that cystectomy is not necessary to provide symptomatic cure in patients with end-stage IC/BPS. Urinary diversion without cystectomy is a highly effective operation and a successful outcome was achieved in all patients. Ileocystoplasty may be offered in carefully selected cases.
Similar content being viewed by others
References
Van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M, Daha LK, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol. 2008;53(1):60–7.
Curhan GC, Speizer FE, Hunter DJ, et al. Epidemiology of interstitial cystitis: a population based study. J Urol. 1999;161(2):549–52.
Berry SH, Elliott MN, Suttorp M, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011;186:540–4.
Link CL, Pulliam SJ, Hanno PM, et al. Prevalence and psychosocial correlates of symptoms suggestive of painful bladder syndrome: results from the Boston area community health survey. J Urol. 2008;180:599–606.
Rovner E, Propert KJ, Brensinger C, The Interstitial Cystitis Data Base Study Group, et al. Treatments used in women with interstitial cystitis: the interstitial cystitis data base (ICDB) study experience. Urology. 2000;56(6):940.
Nordling J, Blaivas JG. Should urinary diversion for bladder pain syndrome/interstitial cystitis include cystectomy? J Urol. 2014;191(2):293–5.
Nielsen KK, Kromann-Andersen B, Steven K, et al. Failure of combined supratrigonal cystectomy and Mainz ileocecocystoplasty in intractable interstitial cystitis: is histology and mast cell count a reliable predictor for the outcome of surgery? J Urol. 1990;144:255.
Webster GD, Galloway N. Surgical treatment of interstitial cystitis. Indications, techniques, and results. Urology. 1987;29:34.
Peeker R, Aldenborg F, Fall M. The treatment of interstitial cystitis with supratrigonal cystectomy and ileocystoplasty: difference in outcome between classic and nonulcer disease. J Urol. 1998;159:1479.
Rossberger J, Fall M, Jonsson O, et al. Longterm results of reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis: subtyping is imperative. Urology. 2007;70(4):638–42.
International Continence Society (ICS) (2009) Incontinence. Chapter 23 Interstitial Cystitis. Available at: http://www.ics.org/Publications/ICI_4/book.pdf. Accessed 21 March 2014.
Habler HJ, Janig W, Koltzenburg M. Activation of unmyelinated afferent fibres by mechanical stimuli and inflammation of the urinary bladder in the cat. J Physiol. 1990;425:545–62.
Floyd K, Hick VE, Morrison JFB. Mechanosensitive afferent units in the hypogastric nerve of the cat. J Physiol. 1976;259:457–71.
Iggo A. Tension receptors in the stomach and urinary bladder. J Physiol. 1955;128:593–607.
Oliver S, Fowler C, Mundy A, et al. Measuring the sensations of urge and bladder filling during cystometry in urge incontinence and the effects of neuromodulation. Neurourol Urodyn. 2003;22:7–16.
Lowe EM et al. Increased nerve growth factor levels in the urinary bladder of women with idiopathic sensory urgency and interstitial cystitis. BJUI. 1997;79(4):572–7.
Yoshimura N et al. Bladder overactivity and hyperexcitability of bladder afferent neurons after intrathecal delivery of nerve growth factor in rats. J Neurosci. 2006;26(42):10847–55.
Birder LA, de Groat WC. Mechanisms of disease: involvement of the urothelium in bladder dysfunction. Nat Clin Pract Urol. 2007;4:46.
Pang X, Marchand J, Sant GR, et al. Increased number of substance P positive nerve fibres in the interstitial cystitis. Br J Urol. 1995;75:744–50.
Sun Y, Keay S, De Deyne PG, et al. Augmented stretch activated adenosine triphosphate release from bladder uroepithelial cells in patients with interstitial cystitis. J Urol. 2001;166(5):1951–6.
Parsons CL. The role of the urinary epithelium in the pathogenesis of interstitial cystitis/prostatitis/urethritis. Urology. 2007;69(S4):9–16.
Jiang W, Morrison JFB. The effects of high urinary potassium concentration on pelvic nerve mechanoreceptors and “silent” afferents in the rat bladder. Adv Exp Med Microbiol. 1995;385:237.
Born M, Pahner I, Ahnert-Hilger G, et al. The maintenance of the permeability barrier of bladder facet cells requires a continuous fusion of discoid vesicles with the apical plasma membrane. Eur J Cell Biol. 2003;82(7):343–50.
Flood HD, Malhotra SJ, O’Connell HE, et al. Long-term results and complications using augmentation cystoplasty in reconstructive urology. Neurourol Urodyn. 1995;14:297–309.
Kim HJ, Lee JS, Cho WJ, et al. 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;21(S1):69–73.
Andersen AV, Granlund P, Schultz A, et al. Long-term experience with surgical treatment of selected patients with bladder pain syndrome/interstitial cystitis. Scand J Urol Nephrol. 2012;46(4):284–9.
Peeker R, Fall M. Toward a precise definition of interstitial cystitis: further evidence of differences in classic and nonulcer disease. J Urol. 2002;167:2470–2.
Jhang JF, Hsu YH, Kuo HC. Urothelial functional protein and sensory receptors in patients with interstitial cystitis/bladder pain syndrome with and without Hunner’s lesions. Urology. 2016;98:44–9.
Logadottir Y, Fall M, Kåbjörn-Gustafsson C, et al. Clinical characteristics differ considerably between phenotypes of bladder pain syndrome/interstitial cystitis. Scand J Urol Nephrol. 2012;46(5):365–70.
Norus T, Fode M, Nordling J. Ileal conduit without cystectomy may be an appropriate option in the treatment of intractable bladder pain syndrome/interstitial cystitis. Scand J Urol. 2014;48(2):210–5.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary Figure 1
O’Leary Sant questionnaire (DOCX 166 kb)
Supplementary Figure 2
Global response assessment (DOCX 38 kb)
Supplementary Table 1
National Institute of Diabetes & Digestive & Kidney Diseases criteria for diagnosis of interstitial cystitis (DOCX 13 kb)
Rights and permissions
About this article
Cite this article
Redmond, E.J., Flood, H.D. The role of reconstructive surgery in patients with end-stage interstitial cystitis/bladder pain syndrome: is cystectomy necessary?. Int Urogynecol J 28, 1551–1556 (2017). https://doi.org/10.1007/s00192-017-3307-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-017-3307-6