Role of Surgery in Bladder Pain Syndrome

Bladder pain syndrome is a clinical condition with many aspects to its presentation and numerous suggested treatments, many of which remain controversial. Reconstructive surgery should only be considered when all the conservative options have been exhausted and only after careful counselling. The purpose of this review is to demonstrate the current evidence in the surgical management of this disease, preparatory to which we have reviewed the surgical aspects. For medical treatment, the evidence base is of poor quality and based on case series. Nevertheless, in carefully selected patients after appropriate counselling, excellent results can be achieved both with total cystectomy and augmentation cystoplasty or a continent or incontinent diversion. We reviewed the various success rates of the treatments which are described. A multidisciplinary approach is essential to a successful outcome, and it is essential to consider not only the urological, but also broader medical and psychological consequences seen with bladder pain syndrome. Further research should focus on clearly categorizing the patients with well-defined clinical criteria to provide high-quality evidence to support the selection of the most effective treatment.