Aya Niimi1, Akira Nomiya2,3, Yukio Yamada2,4, Motofumi Suzuki5, Tetsuya Fujimura2, Hiroshi Fukuhara2, Haruki Kume2, Yasuhiko Igawa6, Yukio Homma2. 1. Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan. niimia-uro@h.u-tokyo.ac.jp. 2. Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan. 3. Department of Urology, Mitsui Memorial Hospital, Chiyoda-ku, Tokyo, Japan. 4. Department of Urology, Japan Red Cross Medical Centre, Shibuya-ku, Tokyo, Japan. 5. Department of Urology, Tokyo Teishin Hospital, Chiyoda-ku, Tokyo, Japan. 6. Department of Continence Medicine, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Abstract
AIMS: Hydrodistension of the bladder, with optional fulguration of Hunner lesions, is one of the recommended therapies for interstitial cystitis (IC). The aims of this study are to evaluate long-term outcomes of hydrodistension and identify outcome predictors. METHODS: The study cohort was 191 newly diagnosed IC patients (155 women and 36 men) who underwent hydrodistension with fulguration of Hunner lesions if detected between 2007 and 2013 at our institution. The primary outcome was therapeutic failure, which was defined as repeat hydrodistension, bladder instillation therapy, or narcotic use for pain control. Clinical features, including comorbidities and endoscopic findings, were analyzed along with the outcome. RESULTS: The cohort comprised 126 patients of Hunner type IC and 65 patients of non-Hunner type IC. The mean time to therapeutic failure was 28.5 months in Hunner type IC and 25.2 months in non-Hunner type IC. The therapeutic failure rate was higher in non-Hunner type IC at 17.3 months; however, the long-term outcomes reversed thereafter. The mean time to therapeutic failure was shorter in patients with lumbar spinal stenosis (LSS) or irritable bowel syndrome (IBS). Multivariate analysis identified LSS as a predictor for failure in Hunner type IC and non-Hunner type IC (HR = 18.8, P = 0.001; HR = 3.8, P = 0.028, respectively) and IBS in non-Hunner type IC (HR = 18.0, P = 0.008). CONCLUSIONS: Bladder hydrodistension, with fulguration of the Hunner lesions, improved IC symptoms. The outcome was worse in non-Hunner type IC shortly after hydrodistension but eventually comparable across the two types. Concomitant LSS and IBS were predictors for poor outcome. Neurourol. Urodynam. 35:965-969, 2016.
AIMS: Hydrodistension of the bladder, with optional fulguration of Hunner lesions, is one of the recommended therapies for interstitial cystitis (IC). The aims of this study are to evaluate long-term outcomes of hydrodistension and identify outcome predictors. METHODS: The study cohort was 191 newly diagnosed IC patients (155 women and 36 men) who underwent hydrodistension with fulguration of Hunner lesions if detected between 2007 and 2013 at our institution. The primary outcome was therapeutic failure, which was defined as repeat hydrodistension, bladder instillation therapy, or narcotic use for pain control. Clinical features, including comorbidities and endoscopic findings, were analyzed along with the outcome. RESULTS: The cohort comprised 126 patients of Hunner type IC and 65 patients of non-Hunner type IC. The mean time to therapeutic failure was 28.5 months in Hunner type IC and 25.2 months in non-Hunner type IC. The therapeutic failure rate was higher in non-Hunner type IC at 17.3 months; however, the long-term outcomes reversed thereafter. The mean time to therapeutic failure was shorter in patients with lumbar spinal stenosis (LSS) or irritable bowel syndrome (IBS). Multivariate analysis identified LSS as a predictor for failure in Hunner type IC and non-Hunner type IC (HR = 18.8, P = 0.001; HR = 3.8, P = 0.028, respectively) and IBS in non-Hunner type IC (HR = 18.0, P = 0.008). CONCLUSIONS: Bladder hydrodistension, with fulguration of the Hunner lesions, improved IC symptoms. The outcome was worse in non-Hunner type IC shortly after hydrodistension but eventually comparable across the two types. Concomitant LSS and IBS were predictors for poor outcome. Neurourol. Urodynam. 35:965-969, 2016.
Authors: T Bschleipfer; R Doggweiler; D Schultz-Lampel; J de Jong; A Gonsior; J Hensen; E Heßdörfer; B T Kaftan; A Kuhn; U Kunzendorf; A Lampel; A Landmesser; A Loch; O Moormann; B Müller; J Neuhaus; A Reich; R Roth; S Schumacher; R Stratmeyer; W Vahlensieck; A Wördehoff; B Münder-Hensen Journal: Urologe A Date: 2019-11 Impact factor: 0.639