Therapeutic Endoscopic Treatment Plus Maintenance Dimethyl Sulfoxide Therapy Prolongs Recurrence-Free Time in Patients With Hunner Type Interstitial Cystitis: A Pilot Study

Abstract

To evaluate whether hydrodistention with fulguration of Hunner lesions (HD/FUL) plus maintenance dimethyl sulfoxide (DMSO) therapy prolongs the recurrence-free time in patients with Hunner type interstitial cystitis (IC). Methods: The study enrolled patients with Hunner type IC who required repeat HD/FUL due to recurrence of IC symptoms after the first HD/FUL at our institution. All patients received a second HD/FUL plus maintenance DMSO therapy. The maintenance DMSO therapy was performed every 2 weeks for a total of 8 instillations, and then once every 4 weeks thereafter. The recurrencefree time from HD/FUL to therapeutic failure was estimated using the Kaplan-Meier method. The recurrence-free time between the first HD/FUL and second HD/FUL plus maintenance DMSO therapy was statistically compared using the log-rank test. Results: A total of 21 patients (mean age, 66.3 ± 10.8 years) with Hunner type IC were evaluated. The recurrence-free time for the second HD/FUL plus maintenance DMSO therapy was significantly longer than that for the first HD/FUL (P < 0.0001).

Multimodal therapies and strategies for the treatment of interstitial cystitis/bladder pain syndrome in Taiwan

“…Of the 51 articles in MEDLINE, 7 focused on the treatment of HIC, including bladder instillation with dimethyl sulfoxide solution (DMSO), 68,69 triamcinolone acetonide, 70 tacrolimus, 71 bladder injection with human embryonic stem cell, 72 and the gold standard HIC treatment with fulguration of Hunner's lesion 73,74 . The other 18 studies focused on intravesical therapy of NHIC, including analysis and interpretation of published data showing cure of IC/BPS by uterosacral ligament repair, 75 clorpactin instillation, 76 intravesical hyaluronic acid (HA) instillation 77–79 or botulinum toxin‐A (BoNT‐A) injection 80–84 or combined treatment, 85 intravesical lidocaine instillation, 86,87 DMSO instillation, 88,89 intravesical injections of platelet‐rich plasma (PRP), 90 comparison of autonomic responses in different anesthesia types, 91 and stem cell treatment 92 .…”

Management of Hunner Lesion in Interstitial Cystitis/Bladder Pain Syndrome Patients

“…To prevent recurrence, the role of postoperative medication or intravesical treatment should be investigated. A recent pilot study reported that hydrodistension with fulguration of Hunner lesion plus maintenance DMSO therapy prolonged the recurrence-free time in patients with IC/BPS with Hunner lesion [20].…”