Elsevier

Urology

Volume 97, November 2016, Pages 73-79
Urology

Female Urology, Urodynamics, Incontinence, and Pelvic Floor Reconstructive Surgery
Is Urethrectomy Necessary During Cystectomy in Patients With Interstitial Cystitis or Bladder Pain Syndrome?

https://doi.org/10.1016/j.urology.2016.07.003Get rights and content

Objective

To assess the outcome of cystectomy and cystourethrectomy in patients with intractable interstitial cystitis or bladder pain syndrome, and to identify whether urethrectomy is necessary.

Methods and Materials

During 2007-2014, 18 women were eligible and elected for surgical treatment after conservative treatment failed. Seven cystectomies with ileal conduit urinary diversions, 8 cystourethrectomies with ileal conduit urinary diversions, and 3 supratrigonal cystectomy with orthotopic ileocystoplasty were performed. Patient histories, perioperative medical records, and follow-up outcomes were evaluated and summarized.

Results

Patients reported subjectively improved social function and mental condition secondary to decreased urination frequency postoperatively. Pain also significantly decreased compared with baseline. To date, additional surgery to alleviate persistent symptoms or postoperative complications has not been necessary. Furthermore, there was no association between reported urethral pain and the initial transvaginal urethrectomy incidence (P = .326). More operation time and longer postoperative hospitalization duration were recorded without better surgical outcomes in the urethrectomy group (P values <.05).

Conclusion

Cystectomy and cystourethrectomy is effective and adequate treatment for interstitial cystitis or bladder pain syndrome, and our experience indicates that urethrectomy is not routinely needed. However, further long-term, prospective studies involving a larger study group are needed.

Section snippets

Materials and Methods

The medical records of the urogynecology and neurourology department outpatients experiencing frequent and painful urination for a long duration were reviewed. A voiding diary lasting at least 3 consecutive days, a detailed symptom history, physical examination, urinalysis, immunological blood test, and psychosomatic evaluation were performed initially to rule out other conditions including overactive bladder, urinary tract infection, colpitis, immune system disorders, and psychosomatic

Results

During the period from 2007 to 2014, 332 consecutive male and female outpatients were diagnosed and treated for IC/BPS. In total, 18 women (5.42%) with a median age of 63.0 years (interquartile range [IQR] from 55.5 to 67.8) were eligible and elected for surgical intervention due to conservative treatment failure. The baseline population preoperative characteristics are presented in Table 1. All O'Leary-Sant questionnaire indices scored 20, reflecting the severity of the condition. Among the

Comment

We summarized our clinical experience and postoperative outcomes in 18 patients who underwent surgery for intractable IC/BPS. The diagnosis and conservative treatment was based on the American Urological Association guidelines.2 Surgical candidate identification and operative planning were evidence-based and tailored to each case. Although the technique remains controversial,17 urinary diversion without cystectomy has reportedly promising outcomes in select patients. In a long-term study,

Conclusion

Based on the present understanding of interstitial cystitis or bladder pain syndrome and available medical management options, major surgery cannot be completely avoided; however, careful and thorough preoperative evaluation of the individual benefits and risks is required. Favorable subjective and objective outcomes can be obtained in appropriately selected patients. Transvaginal urethrectomy was not recommended in the initial major surgery, yet it is difficult to draw generalizations with

Financial disclaimer: The authors declare that they have no relevant financial interests.

De-Yi Luo and Tong-Xin Yang contributed equally to this work and should be considered as co-first author.

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