Adjuvant hydrodistension under epidural anesthesia for interstitial cystitis.
BACKGROUND
Hydrodistension is the first choice of treatment for interstitial cystitis because it allows for diagnosis, bladder biopsy and treatment. However, the method and efficacy of hydrodistension are variable. We performed adjuvant hydrodistension and examined the efficacy and factors that influence prognosis.


METHODS
Fifty-two patients participated in the present study as subjects; they satisfied the diagnostic inclusion and exclusion criteria established by the National Institute of Diabetes, Digestive and Kidney Disease (NIDDK) in 1987, USA. Under epidural anesthesia, the bladder was repeatedly distended up to the maximal bladder capacity for treatment, diagnosis and biopsy. Hydrodistension was performed again on the following day for approximately 30 min under epidural anesthesia in a ward until macroscopic hematuria disappeared.


RESULTS
Five patients were classified into the good, 30 into the moderate and 17 into the poor response group. In the good response group, three patients had type I allergy and one patient did not fulfil all of the positive factors in the NIDDK criteria. The poor response group included one patient with collagen disease. The poor response group was further divided into two subgroups based on bladder capacity. One subgroup included eight patients with a bladder capacity of less than 100 mL and vesicoureteral reflux (VUR). The other subgroup included nine patients with a bladder capacity of more than 100 mL. Among these nine patients there were five patients who lacked one or two positive factors in the NIDDK criteria.


CONCLUSIONS
Adjuvant hydrodistension under epidural anesthesia is effective for about 70% of patients for more than 3 months. It can be performed in a ward without any serious complications. It was observed that patients lacking one or two positive factors were included in the good and poor response groups.
Yamada
Tetsuo
T
Department of Urology, National Sagamihara Hospital, Kanagawa, Japan. t-yamada@sagamihara-hosp.gr.jp
Murayama
Tetsuo
T
Andoh
Masahiko
M
D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage; D003095:Collagen Diseases / Q000503:physiopathology; D018856:Cystitis, Interstitial / Q000175:diagnosis / Q000628:therapy*; D004106:Dilatation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000503:physiopathology; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012965:Sodium Chloride; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D014718:Vesico-Ureteral Reflux / Q000503:physiopathology
D000779:Anesthetics, Local; D012965:Sodium Chloride; D008619:Mepivacaine