Interstitial cystitis: Surgical therapy

Abstract

Between May 1982 and June 1996 at the Department of Urology of Padua University, 13 patients (12 women and 1 man) underwent augmentation/substitution cystoplasty for interstitial cystitis (CI) refractory to conservative management. Median bladder capacity was 70 ml (less than 400 ml under anesthesia in all cases). Two patients underwent subtotal cystectomy and substitution cystoplasty using sigmoid segment; in 7 patients a supratrigonal cystectomy and substitution cystoplasty with sigma (2 cases) and ileum (5 cases) was performed; in 4 patients simple bladder augmentation after large longitudinal bladder incision was performed. Mean post-operative follow-up was 84 months (range 4-173). Post operative median spontaneous bladder capacity was 290 ml and a subjective and objective good result was obtained in 10 out of 13 patients. Four patients had 5 post operative complications: one stenosis of the sigmoido-vesical junction, one ileal segment retraction, one septic temporary acute renal failure, two persistent complete urinary retention. The first two cases needed reoperation and the last two clean intermittent self-catheterization. Supratrigonal cystectomy with substitution enterocystoplasty, using detubularized/configured bowel segment, is the best surgical option in patients with CI with decreased bladder capacity and pain correlated to bladder filling. Post-operative clean intermittent self-catheterization must always be considered during preoperative evaluation.