We aimed to investigate the impact of various bladder lesions on the clinical symptoms and recurrence of interstitial cystitis (IC).
IC patients who underwent transurethral resection and cauterization (TURC) for Hunner lesions (HLs) were enrolled. Features of HLs-non-inflamed, inflamed, and gradually inflamed-and associated cystoscopic findings, including waterfall bleeding (none, focal, or extensive), submucosal hemorrhage, and mucosal streak, were analyzed to investigate their association with preoperative symptoms and recurrence.
We included 272 procedures from 141 patients (M: F=37:104) with mean age of 61.4±10.5 years. Recurrence was observed in 160 procedures after mean of 15.6 months (range 0.7-91.7); repeat TURC was performed in 131 cases. The number of HLs observed at each procedure was variable, and sufficient bladder filling revealed hidden lesions in 10.7% of cases. Waterfall bleeding was frequently accompanied with inflamed/gradually inflamed HLs. Inflammatory HLs were associated with smaller functional bladder capacity (FBC) and preoperative urgency (p=0.007, respectively). Extensive waterfall bleeding was associated with smaller FBC (p=0.006). On multivariate analysis, initially inflamed HLs (HR: 1.675, 95% CI: 1.022-2.746, p=0.041) and gradual inflammatory changes in HLs (HR: 1.893, 95% CI: 1.050-3.410, p=0.034) were found to be risk factors for recurrence.
Sufficient bladder filling revealed hidden HLs. The features of HLs were not associated with subjective symptoms; inflamed changes were a predictive factor for IC recurrence and associated with frequent urgency episodes and smaller bladder capacity.
The Journal of urology. 2021 Apr 23 [Epub ahead of print]
Jung Hyun Shin, Bosik Kang, Myung-Soo Choo
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.