Relationship between the frequency of electrocautery of Hunner lesions and changes in bladder capacity in patients with Hunner type interstitial cystitis

Abstract

Electrocautery is a promising treatment option for patients with Hunner type interstitial cystitis (HIC), but frequently requires multiple sessions due to recurrence of the lesions. In the present study, we assessed the relationship between the frequency of electrocautery of Hunner lesions and changes in maximum bladder capacity (MBC) at hydrodistension in a large cohort of 118 HIC patients. Three mixed-effect linear regression analyses were conducted for MBC against (1) the number of sessions; (2) the number of sessions and the time between each session and the first session; and (3) other relevant clinical parameters in addition to the Model (2). The mean number of sessions was 2.8 times. MBC decreased approximately 50 mL for each additional electrocautery session, but this loss was offset by 10 mL for each year the subsequent session was postponed. MBC of < 400 mL at the first session was a significant risk factor for MBC loss with further sessions. No other clinical parameters were associated with MBC over time. This study demonstrates a significant relationship between the frequency of electrocautery of Hunner lesions and MBC changes in HIC patients. Low MBC at the first session is a poor prognostic marker for MBC loss over multiple sessions.

A pilot study on oral cyclosporine A in association with fulguration for the treatment of interstitial cystitis with Hunner's lesions

“…Moreover, HL fulguration demonstrated solid evidence of short‐term benefits, however the lack of long‐term relief usually leads to repeated procedures under general anesthesia. Although some studies have reported no decreased in bladder capacity after repeated fulgurations, 7,19 a recent retrospective study of 118 patients demonstrated a significant relationship between the number of fulgurations and maximal bladder capacity, with an approximately 50 ml decrease for each additional fulguration session 20 . We believed that the introduction of a maintenance treatement of low‐dose CyA immediately following HL fulguration could prevent symptom recurrence by sustainably decreasing the bladder inflammatory condition and therefore decreasing the frequency of fulgurations.…”

“…Although some studies have reported no decreased in bladder capacity after repeated fulgurations, 7,19 a recent retrospective study of 118 patients demonstrated a significant relationship between the number of fulgurations and maximal bladder capacity, with an approximately 50 ml decrease for each additional fulguration session. 20 We believed that the introduction of a maintenance treatement of low-dose CyA immediately following HL fulguration could prevent symptom recurrence by sustainably decreasing the bladder inflammatory condition and therefore decreasing the frequency of fulgurations. To the best of our knowledge, there is no study that has evaluated the long-term efficiency and safety of HL fulguration as the sole local treatment systematically associated with daily oral CyA.…”

Cystectomy for patients with Hunner‐type interstitial cystitis at a tertiary referral center in Japan

“…However, intractable bladder pain and associated lower urinary tract symptoms may persist even after repeated sessions of electrocautery. Some patients progressively develop contracted bladder, which frequently induces VUR and/or hydronephrosis 8 . Cystectomy may be an option for these patients with end‐stage HIC 1‐3 .…”

Interstitial Cystitis as a Plausible Cause of Overactive Bladder in Systemic Sclerosis: A Hypothesis

“…In particular patient-reported outcome measures and self-assessment questionnaires, such as the OAB symptom score (OABSS), the 8-item overactive bladder questionnaire (OAB-v8), and Overactive Bladder-Bladder Assessment Tool (OAB-BAT) are frequently preferred in clinical trials [14,21,22]. In contrast, the diagnosis of IC is made according to American Urological Association and East Asian clinical guidelines [3,23,24]. Accordingly, cystoscopy (and histological) and/or urodynamic studies are recommended in case the diagnosis is still in doubt after a careful medical history, physical examination, and laboratory examination [24].…”

“…The underlying pathophysiological mechanism of this debilitating condition is still unclear. Recently, IC has been divided into two categories according to the presence or absence of reddish mucosal lesions with abnormal capillary structures in the bladder, which are known as Hunner lesions [3]. IC with Hunner lesions (Hunner-type IC) is regarded as a distinct immunological inflammatory disease entity characterized by urothelial erosion and lymphoplasmacytic infiltration [4].…”