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Utility of urinary diversion in patients with severe interstitial cystitis/painful bladder syndrome
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Utility of urinary diversion in patients with severe interstitial cystitis/painful bladder syndrome
William V. Shappley, III, M.D.1, Robert C. Eyre, M.D.2.
1Brigham & Women's Hospital, Boston, MA, USA, 2Beth Israel Deaconess Medical Center, Boston, MA, USA.
Background: Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic urologic condition characterized by bladder/pelvic pain and urinary frequency/urgency. A minority of patients have symptoms refractory to current pharmacologic, intravesical, and endoscopic therapies. Urinary diversion has traditionally been considered for patients with intractable pain, but published results from small, contemporary American series have been mixed.
Methods: Medical records for 8 consecutive IC/PBS patients undergoing urinary diversion by a single urologist between April 2003 and September 2007 were retrospectively reviewed. Variables assessed include patient age at diagnosis, age at diversion, degree of symptoms, narcotic-dependence, prior therapies, length of hospitalization, complications, post-operative symptoms, and further therapies.
Results: All patients had severe symptoms and were narcotic-dependent prior to diversion. 5 females and 3 males underwent diversion, with a median age of 45.1, an average of 10.3 years after diagnosis. Procedures performed were cystectomy/neobladder (3), continent catheterizable pouch (2), ileal conduit without cystectomy (2), and cystectomy/conduit (1). Average hospital stay was 6 days, and there were no major perioperative complications. Three patients subsequently had alternate diversions performed. Due to recurrent pouchitis, one pouch was revised to a neobladder and the other to an ileal conduit. One of the initial conduits was converted to a neobladder due to the patient’s new desire for a continent diversion. At mean follow-up of 19.6 months, 6 patients are symptom-free and off narcotic medication; the remaining two patients have persistent pelvic pain but no urgency/frequency.
Conclusions: Urinary diversion continues to have a role in the treatment of refractory, severe IC/PBS. Patient selection is essential in minimizing complications and maximizing patient benefit, and further optimization in this regard is required. Our results compare favorably with published contemporary American series. As has been described by others, a continent catheterizable pouch was the least effective urinary diversion in our series due to recurrent pouchitis.
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