RESUMO
INTRODUCTION: We report our experience with endoscopic ablation of Hunner's lesions in women with interstitial cystitis (IC). METHODS: A chart review was performed on 14 patients with IC symptoms who were identified to have bladder lesions and underwent endoscopic ablation. A Hunner's lesion was identified as an area of erythema that reproduced the patients' pain when touched by the cystoscope. Pathology reports were reviewed and improvement in pain was used as the main outcome measure. RESULTS: Of the 14 patients, 12 had more than 50% symptomatic improvement and 8 patients reported 100% improvement. Mean improvement was 76%. In all patients who improved, the biopsy specimen showed inflammatory cystitis, often with epithelial denudation. Four patients had symptomatic recurrence, but all had improvement after repeat ablation. CONCLUSION: Endoscopic ablation of Hunner's lesions improves symptoms in IC patients. Recurrence of symptoms should prompt repeat cystoscopy to identify recurrent lesions, as repeat ablation offers symptomatic improvement.
RESUMO
Conventional teaching has maintained that the detrusor musculature is well-coupled and unilateral innervation should prompt a coordinated detrusor contraction. We present the case of a 17-year-old girl with a tethered spinal cord, unilateral neurologic symptoms and fluoroscopic evidence of ipsilateral hemiparesis of the bladder unresponsive to cord detethering. This adds to a small body of evidence that the bladder smooth muscle is less well-coupled than once believed.
