Treatment of intravesical instillation with fulguration-hydrodistention on female interstitial cystitis / 北京大学学报(医学版)

OBJECTIVE@#To investigate the efficacy and safety of intravesical instillation of heparin/alkalized lidocaine (lidocaine mixed with sodium bicarbonate) combined with hydrodistension and transurethral fulguration in the treatment of female interstitial cystitis (IC).@*METHODS@#Female patients who attended the Department of Urology at the First Hospital of China Medical University between January 2012 and December 2020 and met the diagnostic criteria proposed in the guidelines of the American Urological Association with a new diagnosis of IC were selected for retrospective analysis. Cystoscopy and biopsy of suspicious lesions were performed at the time of diagnosis. All the patients were treated with an intravesical instillation regimen of 2% lidocaine 10 mL + 5% sodium bicarbonate 5 mL + heparin 25 000 IU for a continuous period of 12 months, with or without water dilatation and transurethral electrocautery according to the patient's preference, categorized as hydrodistension and transurethral fulguration (HD/TF) group and non-HD/TF group. The patients were evaluated before and 1, 6, and 12 months after treatment for O'Leary-Sant interstitial cystitis patient symptom index scores (ICSI), interstitial cystitis patient problem index scores (ICPI), visual analog scale (VAS) of suprapubic pain, and functional bladder capacity (FBC) changes.@*RESULTS@#A total of 79 patients were collected in this study. Four (5.1%) of these patients underwent cystectomy due to pathological diagnosis of cancer or treatment failure. The remaining patients were followed up 1, 6 and 12 months after treatment. Repeated-measures ANOVA showed a significant decrease in ICPI, ICSI and VAS and an increase in FBC after treatment compared with before treatment (P < 0.05). FBC continued to decrease during the 1, 6 and 12 months' post-treatment follow-ups, with statistically significant differences; ICSI continued to decrease during the 1 and 6 months post-treatment follow-ups, with statistically significant differences, while the difference between ICSI at 6 months post-treatment and at 12 months' post-treatment was not statistically significant. In the HD/TF group, ICPI continued to decrease in the follow-up from 1 and 6 months after treatment, and the difference was statistically significant, while the difference between ICPI 6 months after treatment and 12 months after treatment was not statistically significant. There was no statistically significant difference between the remaining indicators 1, 6 and 12 months after treatment. ICPI, ICSI, VAS and FBC improved earlier and the changes in VAS and FBC were more significant in the HD/TF group compared with the non-HD/TF group (P < 0.05).@*CONCLUSION@#Heparin/alkalized lidocaine combination of intravesical instillation with hydrodistension and transurethral fulguration for IC is an effective treatment option. Heparin/alkalized lidocaine combination of intravesical instillation may be the first choice of treatment, which can significantly reduce the economic burden of patients and medical insurance system. If patients can accept it, transurethral fulguration with hydrodistension may be considered.

80 cases of hemorrhagic radiation cystitis / 대한비뇨기과학회지

We reviewed 80 cases of hemorrhagic radiation cystitis(HRC) treated in the Department of Urology, Korea Cancer Center Hospital from March, 1985 to July, 1990. The results were obtained as follows. 1. Primary underlying diseases were 1 bladder tumor and 79 cervix cancers. Main presenting symptoms and signs on hospitalization were gross hematuria, passage of blood clots and vesical irritability symptoms. 2. The range of radiation doses to the bladder was from 5,000 to 11,086 cGy and the ratio of cases receiving irradiation over 7,000 cGy was 56.3 %(45 among 80 cases). Time elapsing between termination of radiation therapy and occurrence of HRC was ranged from 1 month to 14.5 years. 3. We performed histopathologic examination in 22 cases. Microscopically, diffuse mucosal edema and ulceration, vascular telangiectasia, submucosal hemorrhage were observed. The areas of ulceration contained acute inflammatory cells at their base and the lamina propria was hyalinized with enlarged atypical fibroblasts and endothelial cells. Of 22 cases, 4 cases of the secondary neoplasia (1 case of transitional cell papilloma, 2 cases of transitional cell carcinoma(TCC) and 1 case of adenocarcinoma), 1 case of TCC of recurrent bladder tumor and 1 case of recurrent cervix cancer invading bladder were observed. 4. Hematuria was controlled in 57 cases receiving transurethral fulguration(TUF), but repeated TUF (2-4 times) was performed for recurrent severe gross hematuria in 7 cases and the ratio of cases requiring re-hospitalization due to recurrent severe gross hematuria after TUF was 16.4%. Of complications due to treatment of HRC, no significant complication was found after TUF, but incontinence due to contracted bladder was occurred in 1 case of 3% formalin instillation.