Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis

Abstract

Aims To evaluate the patterns and predictive factors associated with Hunner lesions (HLs) recurrence in patients with interstitial cystitis (IC). Methods This study was a retrospective analysis of data from patients with IC who underwent transurethral resection and cauterization (TUR‐C) of HLs between October 2011 and December 2017. Symptoms were evaluated using the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF), O'Leary‐Sant Interstitial Cystitis Symptom Index, and Visual Analogue Scale (VAS). Patients attended follow‐up visits every 3 months; cystoscopy was performed immediately in patients with aggravated symptoms. Recurrence was defined as a VAS score greater than or equal to 4 and HLs recurrence on cystoscopy. Results A total of 91 patients were enrolled (25 male, 66 female): median follow‐up was 30.6 months. HLs recurrence occurred in 101 sites (53 patients), 21.8% in the previous TUR‐C site, 18.8% de novo, and 59.4% at both previous and de novo sites. The recurrence rate was approximately 12.7%, 40%, and 55.2% at 6, 12, and 18 months, respectively. A higher PUF bother score was the only predictive factor of recurrence (odds ratio: 1.142, 95% confidence interval: 1.016‐1.284, P = 0.026), with a cut‐off value of 7.5 (sensitivity: 67.9%, specificity: 62.5%). In case of late recurrence (>18 months), there was no predictive factor. Conclusions The HLs recurrence pattern was unpredictable, involving both previous TUR‐C and de novo areas. More accurately defining the HLs resection margin may lead to better surgical outcomes but this remains to be proven.

A Prospective Observational Study of the Recurrence Characteristics of Hunner Lesion After Repeated Transurethral Ablation in Patients With Interstitial Cystitis/Bladder Pain Syndrome

“…This is the first observational study to prospectively analyze the recurrence patterns and characteristics of HL through periodic cystoscopic examination in IC/BPS patients. Recurrence of HL was found at the same site as the previous surgical site in the majority of patients including 50.8% of same site only (A1) and 42.5% of mixed site (A3), which was consistent a previous retrospective study [10]. In cases with a second recurrence, the recurrence pattern remained similar even after repeated procedures.…”

Possible Association between Bladder Wall Morphological Changes on Computed Tomography and Bladder-Centered Interstitial Cystitis/Bladder Pain Syndrome

“…Current guidelines suggest that patients with HIC should receive more aggressive treatments, such as triamcinolone injection, transurethral electrocauterization/resection, and even partial cystectomy for Hunner's lesions [1,7,9]. However, Hunner's lesion recurrence has been common and unpredictable, which might involve both previous transurethral resection and cauterization sites and de novo areas [18]. The inflammatory areas in HIC could very likely involve focal or even the entire bladder wall, with the most inflamed lesions possibly erupting and occasionally presenting as Hunner's lesions [19].…”

Safety of Human Embryonic Stem Cell-derived Mesenchymal Stem Cells for Treating Interstitial Cystitis: A Phase I Study

“…Recurrence patterns of Hunner lesions were unpredictable. 24 IC is a loco-extensive disease affecting the entire bladder; bladder tissues are affected by Hunner-type IC presented pan cystitis with varying degrees of severe inflammation and urothelial denudation in the entire bladder. 25 , 26 If Hunner lesions affect the most vulnerable part of the bladder, local control of the lesion is merely a temporary option.…”