Comparison of the Efficacy Between Transurethral Coagulation and Transurethral Resection of Hunner Lesion in Interstitial Cystitis/Bladder Pain Syndrome Patients: A Prospective Randomized Controlled Trial
Comparison of the Efficacy Between Transurethral Coagulation and Transurethral Resection of Hunner Lesion in Interstitial Cystitis/Bladder Pain Syndrome Patients: A Prospective Randomized Controlled Trial
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DOI：
10.1016/j.eururo.2020.01.002
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发表时间：
2020-05-01
期刊：
影响因子：
23.4
通讯作者：
Lee, Kyu-Sung
中科院分区：
文献类型：
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作者：
Ko, Kwang Jin;Cho, Won Jin;Lee, Kyu-Sung
间质性膀胱炎/膀胱痛综合征(IC/BPS)是一种以慢性盆腔疼痛为特征的慢性疾病，主要表现为与膀胱相关的慢性盆腔疼痛，目前尚无有效的治疗方法。目的评价经尿道电切术(TUR)和经尿道电凝术(TUC)治疗膀胱炎/膀胱痛综合征(HL)的有效性和安全性。设计、设置和参与者：一项单中心、前瞻性、随机对照试验，包括126例IC/BPS患者。次要结果包括次数、夜尿、排尿日记中的紧急发作次数、O‘leary-Sant间质性膀胱炎症状指数(ICSI)和间质性膀胱炎问题指数(ICPI)、盆腔疼痛和紧迫度/频率(PUF)症状评分、疼痛和复发危险因素的视觉模拟评分(VAS)。结果和限制：两组治疗后无复发时间差异无统计学意义，TUR组差异12.2mo(95%可信区间，11.1~17.6)，差异11.5mo(95%CI，9.03~16.1；P=0.735)。两组在日间平均频率、夜间尿频、紧张性发作、ICSI、ICPI、PUF症状评分和疼痛VAS超过12个月方面均无差异。无论治疗类型如何，与基线相比，所有症状问卷和疼痛都有显著改善(ALL，p<；0.05)。治疗类型(TUR或TUC)、年龄、性别、既往水肿史和HLS数目对复发没有影响。TUR组膀胱损伤发生率(7.9%)高于TUC组(3.4%)。结论TUR组与TUR组在无复发时间及对疼痛等尿路症状的影响方面无明显差异。考虑到与手术相关的并发症，外科医生可以选择他/她最熟悉和最舒适的方法。患者概述对于有Hunner病变的膀胱痛综合征患者，内镜下切除和凝固病变都是有效的治疗方法。
BackgroundInterstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by chronic pelvic pain related to the bladder with no effective treatment options.ObjectiveTo evaluate the efficacy and safety of transurethral resection (TUR) and transurethral coagulation (TUC) as treatments for Hunner lesion (HL) in IC/BPS.Design, setting, and participantsA single-center, prospective, randomized controlled trial involving 126 patients with HL in IC/BPS.InterventionTUR or TUC.Outcome measurements and statistical analysisPrimary outcome was recurrence-free time after surgery. Secondary outcomes included change of the number of frequency, nocturia, urgency episodes in voiding diaries, O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), pelvic pain and urgency/frequency (PUF) symptom scale, and visual analog scale (VAS) for pain and risk factors for recurrence.Results and limitationsThere were no differences in the recurrence-free time between treatment groups, a difference of 12.2 mo (95% confidence interval [CI], 11.1–17.6) for TUR, and a difference of 11.5 mo (95% CI, 9.03–16.1;p= 0.735) for TUC. No difference was found in decreased mean daytime frequency, nocturia, urgency episodes, ICSI, ICPI, PUF symptom scale, and VAS for pain between both groups over 12 mo. Regardless of treatment types, there were significant improvements in all symptom questionnaires and pain compared with baseline (all,p< 0.05). Treatment type (TUR or TUC), age, sex, previous history of hydrodistension, and number of HLs did not affect recurrence. Incidence of bladder injury was higher in the TUR group (7.9%) than in the TUC group (3.4%).ConclusionsThere was no difference in the recurrence-free time and effect on urinary symptoms, including pain between TUC and TUR, for HL. Taking into account procedure-related complications, the surgeon can choose the method with which he/she is most familiar and comfortable.Patient summaryIn patients with bladder pain syndrome with Hunner lesions, both endoscopic resection and coagulation of the lesions are effective treatments.