Interstitial cystitis/bladder pain syndrome as referred pain from injured T12/L1 nerves: symptomatic improvement with resection of ilioinguinal and iliohypogastric nerves.

OBJECTIVE To evaluate the specific contribution of ilioinguinal (II) and iliohypogastric (IH) nerve injury and referred pain to interstitial cystitis/bladder pain syndrome (IC/BPS) and patient-reported chronic pelvic pain (CPP), and to enumerate the effects of II and IH nerve resection on the pain and voiding symptoms in patients with IC/BPS. MATERIALS AND METHODS This was a prospective cohort study of eight patients with ICS/BPS who had prior abdominal surgery. All patients received diagnostic image guided T12/L1 nerve blocks, followed by II and IH nerve resections. Validated O'Leary-Sant ICS symptom indices (OSPI) and pelvic pain and urgency/frequency patient symptoms scale (PUF) scores were collected at specified intervals pre- and post-operatively. RESULTS Median scores at pre-operative (OSPI 13.9, PUF 20.4) and one week time points (OSPI 5.9, PUF 11), as well as differences between pre-operative and ten month time points (OSPI 3.7, PUF 6) were all statistically significant (p= 0.008 and 0.009 at 1 week, and 0.007 and 0.008 at 10 months, for OSPI and PUF respectively). The mean difference in score from pre-operative to longest follow-up as measured by the OSPI was -14.4 (p < 0.001) and by PUF -10.3 (p < 0.001). All time points registered demonstrated improvement in pain scores. There were no surgical complications or adverse events. CONCLUSION II and IH nerve resection may be an effective and durable treatment option for those with prior abdominal surgery who have referred ICS/BPS pain from these injured nerves.