Elsevier

Urology

Volume 82, Issue 4, October 2013, Pages 829-833
Urology

Female Urology
Cystectomy for Ulcerative Interstitial Cystitis: Sequelae and Patients' Perceptions of Improvement

https://doi.org/10.1016/j.urology.2013.06.043Get rights and content

Objective

To evaluate the outcomes after cystectomy for ulcerative interstitial cystitis (IC).

Methods

Medical records were reviewed for history, operative data, and postoperative events. A mailed survey assessed preoperative symptom severity/duration, providers seen, and symptom changes on 7-point scaled global response assessments. Descriptive statistics were performed.

Results

Of 10 women (mean age 64 ± 12.5 years), 9 had cystectomy with ileal conduit and 1 had a neobladder. All had previous cautery of Hunner's ulcer (median 3.0 cautery procedures). Maximum bladder capacity at first and last cautery was median 325 and 188 mL, respectively. Median operative time was 321 minutes, blood loss was 200 mL (range, 100-900), 4 of 10 were transfused, and length of stay was 8 days. During a mean follow-up of 3.9 years, 6 patients required 1 or more reoperations, including hernia repair (2), urostomy revision (2), revision of ureteroileal anastomosis (1), small bowel resection (1), and neobladder cutaneous fistula repair (1). Survey respondents (n = 9) reported having seen (mean) 5.4 ± 3.8 providers before cystectomy. Median duration of symptoms was 5 years, and day and nighttime urinary frequencies were 30 and 15 times, respectively. Postoperatively, IC pain had resolved in all patients except for one. On the global response assessments, patients had moderate/marked improvement in overall symptoms (8 of 8), pain (9 of 9), sexual function (4 of 6), and quality of life (8 of 9), 7 of 9 were very satisfied with the treatment, and 8 of 9 would make the same decision again.

Conclusion

Despite subsequent reoperations, symptom improvements lead to high levels of satisfaction with cystectomy for IC.

Section snippets

Materials and Methods

After receiving institutional review board approval, we identified adult men and women (aged 18-90 years) from clinic and hospital billing records at our institution with history of IC/BPS, Hunner's ulcers, and bladder removal. Patients who had IC/BPS and cystectomy for cancer were excluded. All patients had failed to achieve long-term symptom control with ulcer cautery or conservative treatments. One patient had a neobladder created in standard fashion with terminal ileum after urethra-sparing

Results

Ten women with a history of IC/BPS (mean age 64 ± 12.5 years) had cystectomy between 2004 and 2011. Two urologists performed all surgeries. One surgeon created a Hautmann neobladder with terminal ileum after urethral sparing cystectomy in 1 patient and in another, performed a simple cystectomy and ileal conduit urinary diversion. In the remaining 8 patients, the second surgeon performed a simple cystectomy robotically followed by open ileal conduit urinary diversion through an approximately 5-7

Comment

Cystectomy relieved pain and other symptoms in almost all the patients in this study; however, IC/BPS symptoms can persist even after partial or complete bladder removal. In a small series of patients after supratrigonal cystectomy with ileocecocystoplasty, treatment failure required secondary cystectomy and conduit formation in 6 of 8 patients.1 In another study of 41 patients (2 with Hunner's ulcers), 5 had cystectomy and 36 had bladder-conserving procedures. However, 13 of the 36 underwent

Conclusion

In carefully selected patients, cystectomy may be the only reasonable alternative for refractory symptoms especially in those with ulcerative IC/BPS. Overall, patients in this study achieved symptom relief and were quite satisfied with their decision to have the procedure. Before considering cystectomy, patients should be carefully evaluated for potential surgical risks and criteria to ensure they meet current treatment guidelines. Patients should fully understand the risk-benefit ratio

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  • Electrosurgical management of Hunner ulcers in a referral center's interstitial cystitis population

    2015, Urology
    Citation Excerpt :

    Additionally, ulcerative patients have excellent responses to local treatments11 suggesting that the subtype is more a condition of the bladder. We previously demonstrated the efficacy of cystectomy leading to high levels of patient satisfaction in a small population of ulcerative IC patients' refractory to conservative treatment.6 However, cystectomy is not an acceptable first-line treatment for ulcerative IC.

View all citing articles on Scopus

Funding Support: This work was supported by the Ministrelli Program for Urology Research and Education (MPURE).

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