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The role of reconstructive surgery in patients with end-stage interstitial cystitis/bladder pain syndrome: is cystectomy necessary?

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Abstract

Introduction

Interstitial cystitis is a debilitating condition that has a profound effect on quality of life. Although many approaches to treatment have been explored, no consistently effective treatment has been identified. Reconstructive surgery is offered to patients with refractory IC/BPS; however, expert opinion is divided as to whether simultaneous cystectomy is necessary to achieve symptomatic cure. The aim of this study was to report our experience in the surgical management of IC/BPS in a university teaching hospital.

Methods

The hospital inpatient enquiry (HIPE) system was used to identify patients with IC/BPS who underwent surgery between 1997 and 2013. Medical records were examined and patients were invited to complete three symptom-based questionnaires.

Results

Twelve patients were identified (8 female, 4 male). Reconstructive procedures included urinary diversion without cystectomy (9) and augmentation ileocystoplasty (4). One patient failed to have a sustained improvement in symptoms following ileocystoplasty and later underwent successful urinary diversion. All other patients noted a “marked improvement” in overall symptoms on global response assessment (GRA) and the resolution of bladder pain on a visual analogue sale (VAS). There were no persistent symptoms or complications related to the retained bladder following diversion.

Conclusion

Our study adds to the existing evidence that cystectomy is not necessary to provide symptomatic cure in patients with end-stage IC/BPS. Urinary diversion without cystectomy is a highly effective operation and a successful outcome was achieved in all patients. Ileocystoplasty may be offered in carefully selected cases.

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Authors and Affiliations

  1. Department of Urology, University Hospital of Limerick, Limerick, Ireland

    Elaine J. Redmond & Hugh D. Flood

Authors
  1. Elaine J. Redmond
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  2. Hugh D. Flood
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Corresponding author

Correspondence to Elaine J. Redmond.

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Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Figure 1

O’Leary Sant questionnaire (DOCX 166 kb)

Supplementary Figure 2

Global response assessment (DOCX 38 kb)

Supplementary Table 1

National Institute of Diabetes & Digestive & Kidney Diseases criteria for diagnosis of interstitial cystitis (DOCX 13 kb)

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Redmond, E.J., Flood, H.D. The role of reconstructive surgery in patients with end-stage interstitial cystitis/bladder pain syndrome: is cystectomy necessary?. Int Urogynecol J 28, 1551–1556 (2017). https://doi.org/10.1007/s00192-017-3307-6

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  • DOI: https://doi.org/10.1007/s00192-017-3307-6

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