Hydrodistention, Transurethral Resection and Other Ablative Techniques in the Treatment of Bladder Pain Syndrome

Abstract

Endoscopic treatment of interstitial cystitis was introduced in the beginning of the twentieth century and is still in use although with different applications. The first major step was when empirical observations suggested that hydrodistension of the bladder could ameliorate symptoms. In the absence of better alternatives this treatment was standard for a substantial period of time.

Much later, when a new paradigm was launched and, while preserving the denomination IC, the concept was widened to include a larger population of subjects with bladder pain and cystoscopy and hydrodistension lost its dominating role. Due to unreliable efficacy, hydrodistension has a very limited role today. It has become evident, though, that the classic Hunner type of disease, the primary understanding of the diagnosis IC, stands out as a distinct entity in terms of age at the first appearance of symptoms, endoscopic and histological presentations, neurobiological findings, mast cell expressions and response to various treatments. This includes excellent responses to ablative surgery, in bright contrast to what can be achieved in other bladder pain syndrome (BPS) phenotypes. In clinical practice today, local ablation of lesions by transurethral resection or coagulation can be seen as first-line treatment of ESSIC BPS type 3C disease.