Long-term results of reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis: subtyping is imperative.

OBJECTIVES

To evaluate the long-term outcome after reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis subdivided into subtypes.

METHODS

A total of 47 patients, fulfilling the National Institutes of Health/National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases criteria, were evaluated retrospectively. They all had undergone reconstructive surgery during the 25-year period of 1978 to 2003. The surgical procedures included noncontinent ureteroenterocutaneostomy (12 patients), supratrigonal cystectomy and ileocystoplasty (23 patients), continent urinary diversion (Kock pouch; 10 patients), continent orthotopic diversion (1 patient), and cecocystoplasty (1 patient). The series comprised 34 patients with classic Hunner type disease and 13 patients with nonulcer bladder pain syndrome/interstitial cystitis. The patients were preoperatively assessed by interview, visual analog pain scale, micturition diaries, urinalysis, intravenous urography, urethrocystoscopy, and bladder distension during anesthesia, including biopsy and, in selected cases, urodynamic evaluation. The data were obtained by surveying the clinical records.

RESULTS

For 28 of the 34 patients with classic Hunner-type disease, the initial surgical procedure resulted in complete symptom resolution. Of the remaining 6 patients, 4 were successfully treated with a supplementary diversion procedure, cystectomy, or transurethral ulcer resection in the trigonal remnant. In contrast, only 3 of the 13 patients with nonulcer disease experienced symptom resolution after reconstructive surgery, and 2 of these required a supravesical diversion procedure.

CONCLUSIONS

Reconstructive surgery for refractory bladder pain syndrome/interstitial cystitis is an appropriate last resort only for patients with end-stage Hunner's disease. The decision to embark on major reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis should be preceded by a thorough preoperative evaluation, with emphasis on assessment to determine the relevant subtype (ie, classic or nonulcer disease).