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

Urology. 2019 Nov:133:78-83. doi: 10.1016/j.urology.2019.07.036. Epub 2019 Aug 20.


Objective: 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 (interquartile range [IQR] 1.7). 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 (IQR 621). 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.

MeSH terms

  • Adult
  • Aged
  • Cystitis, Interstitial / complications*
  • Cystitis, Interstitial / surgery*
  • Cystoscopy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Ulcer / complications*
  • Ulcer / surgery*