Surgical management of interstitial cystitis.

For most urologists the decision to operate on a patient with interstitial cystitis is made with extreme caution. The knowledge that this is a nonmalignant disease, that it poses little risk to overall health (although most patients would differ with this assertion), and that surgical intervention may be accompanied by additional complications has relegated open surgical procedures to last on the list of treatments for interstitial cystitis. This reluctance to operate until late in the course of the disease is clearly unsatisfactory. If a successful surgical procedure can performed, it ought to be employed early in the course of the patient's management and not withheld after the unfortunate patient has been subjected to a host of unsatisfactory conservative treatments. There is a need for balance between timidity and surgical aggression in the management of this dreadful condition. There is a need to identify the appropriate patients for surgical treatment and to select the most successful procedure. We should not expect to have to move through a series of different procedures for each patient, but rather select the right one the first time. There is an obvious need for a better understanding of the precise cause and pathogenesis of the condition so that alternative forms of treatment may be investigated. Surgery can provide significant relief for many patients with incapacitating symptoms. Cystectomy, either supratrigonal or total, is best reserved for those patients with markedly reduced bladder capacities.