Interstitial Cystitis/Painful Bladder Syndrome

Alis Kolter Panzera, MSN, CRNP

Disclosures

Urol Nurs. 2007;27(1):13-19. 

In This Article

Surgical Approaches

A common surgical intervention is cystoscopy with bladder hydrodistension. Sixty percent of patients undergoing hydrodistention experience an improvement in symptoms as a result (Tchetgen et al., 2005). Although the mechanism of action for symptom relief is not clear, there is evidence that the stretch stimulus from hydrodistension increases heparin-binding epidermal growth factor and reduces antiproliferative factor activity in the urine. As noted previously, cystoscopy with hydrodistention is often used during PBS/IC evaluation and is performed in the same manner as discussed previously. Patients undergoing hydro distention as a treatment for PBS/IC are given pain medications (Percocet® and Pyridium®) for approximately 1 week post-procedure (Tchetgen et al., 2005).

Interstim™ is a surgically implanted neuromodulation de vice that has shown promise for the treatment of urinary frequency and urgency related to PBS/IC. The Interstim device sends a mild electrical pulse to the S3 sacral nerve root which aids in re-establishing normal coordination of the function of the bladder and surrounding pelvic floor muscles. The Interstim device is currently FDA approved for treating urinary urge incontinence, nonobstructive urinary retention, and symptoms of urgency and frequency. Clinical trials are under way for its use in PBS/IC (Whitmore, Payne, Diokno, & Lukban, 2003).

More radical surgical interventions include cystectomy to remove the source of PBS/IC pain. Procedures such as supratrigonal cystectomy with enterocystoplasty or urinary diversion with or without urethrocystectomy are reserved for only the most severe cases and when all other therapies have failed (Tchetgen et al., 2005). Despite these radical measures pain may persist in patients who have up-regulated nervous systems; therefore, these procedures are used rarely.

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