Transurethral Fulguration of Hunner Lesion Was Effective for Primary Management of Pelvic Pain in Patients With Interstitial Cystitis: A Long-Term Follow-Up Study.

Objective: This study aimed to analyze the outcomes of clinical management of patients with interstitial cystitis (IC).

Patients and methods: We retrospectively analyzed the electronic medical records of patients with IC who visited outpatient clinics with pelvic pain between October 2005 and December 2019. Pain was managed with cystoscopic surgery based on transurethral fulguration (TUF) for bladder ulcers. Cystectomy was performed for intractable pelvic pain. Patients were regularly followed and clinical outcomes were analyzed.

Results: Of the 275 patients, 240 patients (57 men, 23.7% and 183 women, 76.3%) underwent initial cystoscopic surgery. Overall median follow-up duration was 21.0 months and mean number of TUF was 1.0 (±0.8). Of these 240 patients, 71 (29.6%) did not require further surgical treatment, whereas 64 (26.7%) required a second TUF for recurrent pelvic pain. The median recurrence interval was 12.0 (interquartile range: 6.0-25.0) months. Of the 64 patients who received a second TUF, 15 (23.4%) underwent a third TUF after a median of 12.0 (interquartile range: 12.0-32.0) months. Of the 15 patients who received a third TUF, five patients required a fourth TUF because of recurrence of pain. One patient received until a seventh TUF. Overall, 168 of 240 patients (70.0%) achieved pain control with TUF. Eighteen patients (7.5%) underwent cystectomy (six patients with urinary diversion and 12 patients with cystectomy with bladder replacement).

Conclusion: TUF-based cystoscopic surgery is an effective basic treatment for pelvic pain management in patients with IC.