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Yu J, Lee CU, Lee KS, Ko KJ. Optimal endoscopic treatment and partial cystectomy with or without bladder augmentation for Hunner-type interstitial cystitis. Low Urin Tract Symptoms 2023; 15:216-224. [PMID: 37750459 DOI: 10.1111/luts.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) presents a significant challenge for urologists in terms of management, owing to its chronic nature and adverse impact on patient quality of life. Given the potential distinction between two disease entities within IC/BPS, namely Hunner-type IC and BPS without Hunner lesion, there is a need for an optimal therapeutic approach that focuses on the bladder lesions in Hunner-type IC. In cases where Hunner lesions are observed, complete transurethral ablation of these lesions should be prioritized as the initial intervention, as it has demonstrated effectiveness in symptom control. However, recurrence remains a limitation of this intervention. The techniques of resection and coagulation are equally effective in terms of symptom relief and recurrence prevention. Reconstructive surgery becomes necessary in cases of end-stage IC/BPS where various therapeutic approaches have failed. Patient selection is crucial in reconstructive surgery, particularly for patients with clear Hunner lesions and small bladder capacity who have not responded to previous treatments. Furthermore, it is vital to consider the patients' expectations and preferences adequately. Based on a comprehensive review of the literature and our own clinical experiences, subtotal cystectomy followed by bladder augmentation is considered a safe and effective surgical option. This stepwise and tailored therapeutic approach aims to optimize patients' quality of life by specifically targeting Hunner-type IC.
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Affiliation(s)
- Jiwoong Yu
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Research Institute for Future Medicine Samsung Medical Center, Seoul, Republic of Korea
| | - Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Faris A, Lane GI, Mehra R, Dadhania V, Crescenze I, Clemens JQ, Romo PB, Stoffel J, Malaeb B, Blair Y, Goh M, Gupta P, Cameron AP. Destroyed bladders: Characterization of progressive inflammatory cystitis. Neurourol Urodyn 2023; 42:1194-1202. [PMID: 37126389 DOI: 10.1002/nau.25195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE We identified a subset of patients with noninfectious cystitis who develop refractory symptoms marked by diffuse inflammatory changes, reduced bladder capacity, and vesicoureteral reflux (VUR), termed here as "progressive inflammatory cystitis" (PIC). Our objective was to describe the phenotype, disease outcomes, and pathologic findings of PIC. MATERIAL AND METHODS A single institution retrospective cohort study of patients with PIC. Patients with a history of pelvic radiation, urologic malignancy, or neurogenic bladder were excluded. We describe cohort characteristics and use bivariate analyses to compare subgroups. Kaplan-Meier methods estimate time to urinary diversion. RESULTS From 2008 to 2020, 46 patients with PIC were identified. The median age of symptom onset was 63 years old (interquartile range [IQR]: 56, 70) and the most common presenting symptoms were urinary urgency/frequency (54%) and incontinence (48%). Urodynamics showed a median maximum bladder capacity of 80 mL (IQR: 34, 152), commonly with VUR (68%) and hydronephrosis (59%). Ultimately 36 patients (78%) underwent urinary diversion at a median of 4.5 years (IQR: 2, 6.5) after symptom onset. Significant pathologic findings include presence of ulceration (52%), acute and chronic inflammation (68%), including eosinophils (80%), lymphoid follicles (56%), and mast cells in both lamina and muscularis propria (76%). CONCLUSIONS PIC is a newly defined entity characterized by significantly diminished bladder capacity, upper tract changes, and relatively quick progression to urinary diversion. Larger prospective cohort studies are required to further characterize this severe phenotype of chronic noninfectious cystitis, aid earlier diagnosis, and guide management decisions.
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Affiliation(s)
- Anna Faris
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Iryna Crescenze
- Department of Urology, Ohio State University, Columbus, Ohio, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - John Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bahaa Malaeb
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yooni Blair
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Meidee Goh
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Jhang JF, Jiang YH, Kuo HC. Current Understanding of the Pathophysiology and Novel Treatments of Interstitial Cystitis/Bladder Pain Syndrome. Biomedicines 2022; 10:biomedicines10102380. [PMID: 36289642 PMCID: PMC9598807 DOI: 10.3390/biomedicines10102380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/19/2022] Open
Abstract
The pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) is multifactorial. Identifying the clinical characteristics and cystoscopic findings of bladder-centered IC/BPS facilitates optimal treatment strategies targeting the diseased urinary bladder. Patients with Hunner’s lesion (HIC) and without Hunner’s lesion (NHIC) should be treated differently. Based on the histopathological findings, NHIC can be treated with intravesical instillation of urothelial protective agents, such as hyaluronic acid, to cover the urothelial defects. In non-responders, chronic inflammation and higher urothelial dysfunction can be treated with intravesical botulinum toxin A injection, platelet-rich plasma injection, or low-energy shock wave treatment to reduce inflammation, increase tissue regeneration, and improve the urothelial barrier. Patients with HIC should be treated with electrocauterization first; augmentation enterocystoplasty should only be used in end-stage HIC when the contracted bladder is refractory to other treatments. The antiviral agent, valacyclovir, can be used in patients with HIC, small bladder capacity, and high-grade glomerulations. In addition, behavioral modification is always recommended from the beginning of treatment. Treatment with cognitive behavioral therapy interventions in combination with bladder therapy can reduce anxiety and improve treatment outcomes. Herein, recent advances in the pathophysiology and novel treatments for IC/BPS are reviewed.
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Affiliation(s)
| | | | - Hann-Chorng Kuo
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117); Fax: +886-3-8560794
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Ko KJ, Lim J, Yu J, Kang D, Cho J, Lee KS. The impact of Hunner lesion-type interstitial cystitis/bladder pain syndrome on health-related quality of life and the effects of transurethral ablation. Qual Life Res 2022; 31:3221-3228. [DOI: 10.1007/s11136-022-03183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 12/01/2022]
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Akiyama Y, Niimi A, Igawa Y, Nomiya A, Yamada Y, Sato Y, Kawai T, Yamada D, Kume H, Homma Y. Cystectomy for patients with Hunner-type interstitial cystitis at a tertiary referral center in Japan. Low Urin Tract Symptoms 2021; 14:102-108. [PMID: 34704374 DOI: 10.1111/luts.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/28/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the outcomes of partial and total cystectomy in patients with refractory Hunner-type interstitial cystitis (HIC). METHODS Patients with end-stage HIC who underwent supratrigonal partial cystectomy with augmentation ileocystoplasty (PC-CP) or total cystectomy with ileal conduit (TC-IC) were identified retrospectively. Changes in the 11-point numerical rating scale of bladder pain and in 7-grade quality of life (QOL) scores were evaluated. Changes in the O'Leary and Sant's Symptom Index (OSSI) and O'Leary and Sant's Problem Index (OSPI) were analyzed in patients with PC-CP. Peri- and postoperative complications and patient satisfaction with overall outcomes were examined. RESULTS Four patients (one female) underwent PC-CP and 13 (nine females) underwent TC-IC. Bladder pain persisted in three PC-CP patients, but resolved completely in all TC-IC patients. Pain scale and QOL scores improved significantly in patients with TC-IC (P < .01), but not in those with PC-CP. OSSI/OSPI scores did not improve significantly in patients with PC-CP. Three PC-CP patients required clean intermittent catheterization due to voiding dysfunction or persistent pain. Two TC-IC patients developed stricture of the ureteroileal anastomosis, resulting in permanent placement of a ureteral stent in one case and nephrostomy in the other. Satisfaction rate was higher in the TC-IC than in the PC-CP group (76.9% vs 25.0%, P < .05). CONCLUSIONS TC-IC provided reliable pain relief and improved QOL in patients with end-stage HIC, but the small case number and limited methodology restrict interpretation of the results. Further studies are needed to identify appropriate candidates and optimal surgical procedures.
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Affiliation(s)
- Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, New Tokyo Hospital, Matsudo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka, Japan
| | - Akira Nomiya
- Department of Urology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Tokyo, Japan
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Blasenschmerzsyndrom: Schmerzen, Sexualfunktion und Lebensqualität nach OP. Aktuelle Urol 2020; 51:512-516. [PMID: 33232989 DOI: 10.1055/a-1019-5609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Khullar V, Digesu GA, Veit-Rubin N, Sahai A, Rahnama'i MS, Tarcan T, Chermansky C, Dmochowski R. How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI-RS 2018. Neurourol Urodyn 2020; 38 Suppl 5:S71-S81. [PMID: 31821630 DOI: 10.1002/nau.24245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/21/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This paper summarises the discussion in a think tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2018 about the treatment of bladder pain syndrome. AIMS To review the treatments of bladder pain syndrome from behavioural treatments to surgical interventions. MATERIALS AND METHODS Review the literature in the light of the think tank discussions. RESULTS All guidelines recommend different levels of treatment starting with conservative behavioral treatments then introducing oral treatments followed by intravesical instillations. If these treatments fail then more invasive treatments such as botulinum toxin injections, neuromodulation, or surgery could be suggested. CONCLUSION Unfortunately for all treatments, the numbers are limited and, therefore, the evidence base is not strong. Further suggestions for research are suggested.
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Affiliation(s)
- Vik Khullar
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK
| | - G Alessandro Digesu
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Arun Sahai
- Department of Urology, Guy's Hospital, MRC Centre for Transplantation, King's College London, London, UK
| | | | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.,School of Medicine, Koc University, Istanbul, Turkey
| | - Christopher Chermansky
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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Homma Y, Akiyama Y, Tomoe H, Furuta A, Ueda T, Maeda D, Lin ATL, Kuo H, Lee M, Oh S, Kim JC, Lee K. Clinical guidelines for interstitial cystitis/bladder pain syndrome. Int J Urol 2020; 27:578-589. [DOI: 10.1111/iju.14234] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Yukio Homma
- Department of Urology Japanese Red Cross Medical Center Tokyo Japan
| | - Yoshiyuki Akiyama
- Department of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hikaru Tomoe
- Department of Urology Tokyo Women’s Medical University Medical Center East Tokyo Japan
| | - Akira Furuta
- Department of Urology Jikei University School of Medicine Tokyo Japan
| | | | - Daichi Maeda
- Department of Clinical Genomics Graduate School of Medicine Osaka University Osaka Japan
| | - Alex TL Lin
- Department of Urology Taipei Veterans General Hospital National Yang Ming University Taipei Taiwan
| | - Hann‐Chorng Kuo
- Department of Urology School of Medicine Buddhist Tzu Chi General Hospital Tzu Chi University Hualien Taiwan
| | - Ming‐Huei Lee
- Department of Urology Feng‐Yuan Hospital Taichung Taiwan
| | - Seung‐June Oh
- Department of Urology Seoul National University Seoul Korea
| | - Joon Chul Kim
- Department of Urology The Catholic University of Korea Seoul Korea
| | - Kyu‐Sung Lee
- Department of Urology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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Kendall MC. Letter to the Editor regarding the article "Comparison of intra- and postoperative analgesia and pain perception in robot-assisted vs. open radical prostatectomy". World J Urol 2020; 38:2323. [PMID: 31925553 DOI: 10.1007/s00345-020-03081-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/04/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mark C Kendall
- Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.
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