Advanced Management of Patients with Ulcerative Interstitial Cystitis/Bladder Pain Syndrome

Abstract Objectives To describe a stepwise management of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with Hunner's lesions and present single institution long-term outcomes. Methods This is a retrospective review of a single tertiary center experience with management of patients with Hunner's lesions from January 2005 to January of 2015. Patients who met the diagnostic criteria for IC/BPS were included. Systematic approach to treatment of patients with Hunner's lesions is proposed based on our results. Results Fifty-five patients with IC/BPS and Hunner's lesions were included. Mean age was 65.0+/-12.7 years, 76.4%(42/55) were female, and median symptom duration was 2 years (IQR1,7). All patients had a biopsy to rule out malignancy with therapeutic fulguration which resulted in subjective symptom improvement in 81.8%(45/55) and median time to repeat procedures was 12 months (IQR6,21). Triamcinolone injection into the lesion was done in 35 patients and 91.4%(32/35) reported subjective improvement. Repeat injections were done for 74%(26/35) and median time between injections was 8 months (IQR 4, 13). AUA symptom scores and quality of life improved significantly with both treatment modalities. Adjunctive treatment with cyclosporine was used in 47.2%(26/55), and 7.2%(4/55) went on to have a cystectomy. Conclusion Patients with Hunner's lesions benefit from early progression from conservative treatments to endoscopic management. Excellent symptom control can be achieved with biopsy/fulguration and triamcinolone injections but recurrence is common and repeat treatments are needed for most patients.