Does repeated hydrodistension with transurethral fulguration for interstitial cystitis with Hunner's lesion cause bladder contraction?
Does repeated hydrodistension with transurethral fulguration for interstitial cystitis with Hunner's lesion cause bladder contraction?
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DOI：
10.1080/2090598x.2019.1589753
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发表时间：
2019-01-01
影响因子：
1.5
通讯作者：
Yamashita, Kaori
中科院分区：
文献类型：
--
作者：
Tomoe, Hikaru;Yamashita, Kaori
目的：探讨经尿道Hunner病切除或电灼（TUF）后反复膀胱水肿对膀胱容量和间质性膀胱炎（IC）症状的影响。一些IC/BPS指南推荐TUF治疗Hunner病变，尽管复发的可能性很大。患者和方法：研究队列包括2005年7月至2018年6月期间在我院接受TUF和电灼（EC）多次膀胱水肿的44例患有Hunner病变的IC患者。我们分析了患者术前、术后2个月、6个月和12个月的频率-体积图、O’leary Sant间质性膀胱炎症状指数（ICSI）、间质性膀胱炎问题指数（ICPI）和视觉模拟疼痛量表（VAS）。结果：44例hunner型IC患者共行手术117例。根据患者接受TUF的水扩张次数将患者分为三组。组1 （n = 44）、组2 （n = 44）、组3 （n = 21）分别行1次、2次、3次手术。术后6个月，1组平均排空量（AVV）为157 mL，最大排空量（MVV）为228 mL；2组203 mL， 283 mL；3组193 mL， 264 mL。与1组相比，2组AVV （P < 0.01）、3组（P < 0.03）、2组MVV （P < 0.02）显著升高。2组ICSI、ICPI、VAS疼痛评分（P < 0.003, P < 0.01, P < 0.05）、3组（P < 0.001, P < 0.001, P < 0.001）较1组显著降低。结论：复发性Hunner型IC患者反复进行Hunner病变的腹水扩张和TUF合并EC可改善其症状。膀胱容量有增加的趋势，反复的水膨胀与TUF似乎不是膀胱收缩的直接原因。
Objective: To evaluate the effect of repeated bladder hydrodistension with transurethral resection or fulguration (TUF) of Hunner's lesions on bladder capacity and interstitial cystitis (IC) symptoms. TUF for Hunner's lesion is recommended in several IC/BPS guidelines, although recurrence is highly probable.Patients and methods: The study cohort comprised 44 IC patients with Hunner's lesions who underwent multiple bladder hydrodistensions with TUF and electrocautery (EC) at our institution between July 2005 and June 2018. We analysed their frequency-volume chart, O'Leary Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), and visual analogue scale (VAS) for pain, before and at 2, 6, and 12 months after surgery.Results: The 44 Hunner-type IC patients underwent a total of 117 surgeries. Patients were divided into three groups based upon the number of hydrodistensions with TUF they underwent. Group 1 (n = 44), Group 2 (n = 44) and Group 3 (n = 21) underwent one, two, and three surgeries, respectively. At 6 months after surgery, the mean average voided volume (AVV) and maximum voided volume (MVV) were 157 mL and 228 mL in Group 1; 203 mL, 283 mL in Group 2; and 193 mL, 264 mL in Group 3. The AVV in Group 2 (P < 0.01) and Group 3 (P < 0.03), and the MVV in Group 2 (P < 0.02) increased significantly compared to Group 1. ICSI, ICPI and VAS pain score in groups 2 (P < 0.003, P < 0.01, P < 0.05) and 3 (P < 0.001, P < 0.001, P < 0.001) decreased significantly compared to Group 1.Conclusion: Repeated hydrodistension and TUF with EC of Hunner's lesions for recurrent Hunner-type IC patients improved their symptoms. There was a tendency toward an increase in bladder capacity and repeated hydrodistension with TUF did not appear to be a direct cause of bladder contraction.