Andersen Aage Valdemar, Granlund Petter, Schultz Alexander, Talseth Trygve, Hedlund Hans, Frich Lars
Department of Urology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Scand J Urol Nephrol. 2012 Aug;46(4):284-9. doi: 10.3109/00365599.2012.669789. Epub 2012 Mar 27.
The role of major surgery in patients with bladder pain syndrome/interstitial cystitis (BPS/IC) is not fully established. This report presents a single-institution experience with major surgery in patients with disabling BPS/IC where conservative treatment had failed.
Forty-one patients (34 women, seven men) with BPS/IC refractory to conservative treatment underwent major surgery from 1983 to 2004. Surgical approach was determined on a case-by-case basis. Postoperative pain and satisfaction were assessed by a questionnaire.
Cystectomy was the primary procedure in five patients. The remaining 36 patients were primarily operated on with subtotal cystectomy and bladder augmentation (n = 16) or supravesical urinary diversion with intact bladder (n = 20). Thirteen of these patients were later operated on with cystectomy due to persisting pain 12 (6-146) months after the primary procedure. The questionnaire was answered by 38 of 41 patients after a median follow-up of 66 (6-238) months. In total, 28 patients (74%) were free of pain, and 26 patients (68%) were satisfied with the end result. There was no difference in reported pain between cystectomized and non-cystectomized patients. When comparing patients who reported pain at follow-up with those who did not report pain, preoperative length of symptoms was significantly increased, with 12.1 compared to 5.4 years (p = 0.02).
Major surgery is associated with good symptom relief in strictly selected patients with disabling BPS/IC, where conservative treatment has failed. Extended preoperative duration of symptoms may be a predictor for persisting pain after major surgery for BPS/IC.
膀胱疼痛综合征/间质性膀胱炎（BPS/IC）患者接受大手术的作用尚未完全明确。本报告介绍了一家机构对保守治疗失败的重度BPS/IC患者进行大手术的经验。
1983年至2004年，41例（34例女性，7例男性）保守治疗无效的BPS/IC患者接受了大手术。手术方式根据具体病例确定。通过问卷调查评估术后疼痛和满意度。
5例患者接受了膀胱切除术。其余36例患者主要接受了膀胱部分切除术及膀胱扩大术（n = 16）或保留膀胱的膀胱上尿液改道术（n = 20）。其中13例患者在初次手术后12（6 - 146）个月因持续疼痛接受了膀胱切除术。41例患者中有38例在中位随访66（6 - 238）个月后回答了问卷。总体而言，28例患者（74%）无疼痛，26例患者（68%）对最终结果满意。膀胱切除患者和未切除患者报告的疼痛无差异。将随访时报告疼痛的患者与未报告疼痛的患者进行比较，术前症状持续时间显著增加，分别为12.1年和5.4年（p = 0.02）。
对于严格选择的保守治疗失败的重度BPS/IC患者，大手术可有效缓解症状。术前症状持续时间延长可能是BPS/IC大手术后持续疼痛的一个预测因素。
