title: Long-term experience with surgical treatment of selected patients with bladder pain syndrome/interstitial cystitis.
abstract: OBJECTIVE
  The role of major surgery in patients with bladder pain syndrome/interstitial cystitis (BPS/IC) is not fully established. This report presents a single-institution experience with major surgery in patients with disabling BPS/IC where conservative treatment had failed.
  
  
  METHODS
  Forty-one patients (34 women, seven men) with BPS/IC refractory to conservative treatment underwent major surgery from 1983 to 2004. Surgical approach was determined on a case-by-case basis. Postoperative pain and satisfaction were assessed by a questionnaire.
  
  
  RESULTS
  Cystectomy was the primary procedure in five patients. The remaining 36 patients were primarily operated on with subtotal cystectomy and bladder augmentation (n = 16) or supravesical urinary diversion with intact bladder (n = 20). Thirteen of these patients were later operated on with cystectomy due to persisting pain 12 (6-146) months after the primary procedure. The questionnaire was answered by 38 of 41 patients after a median follow-up of 66 (6-238) months. In total, 28 patients (74%) were free of pain, and 26 patients (68%) were satisfied with the end result. There was no difference in reported pain between cystectomized and non-cystectomized patients. When comparing patients who reported pain at follow-up with those who did not report pain, preoperative length of symptoms was significantly increased, with 12.1 compared to 5.4 years (p = 0.02).
  
  
  CONCLUSIONS
  Major surgery is associated with good symptom relief in strictly selected patients with disabling BPS/IC, where conservative treatment has failed. Extended preoperative duration of symptoms may be a predictor for persisting pain after major surgery for BPS/IC.
authors.affiliation: Department of Urology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Aage Valdemar
authors.initials: AV
authors.lastname: Andersen
authors.forename: Petter
authors.initials: P
authors.lastname: Granlund
authors.forename: Alexander
authors.initials: A
authors.lastname: Schultz
authors.forename: Trygve
authors.initials: T
authors.lastname: Talseth
authors.forename: Hans
authors.initials: H
authors.lastname: Hedlund
authors.forename: Lars
authors.initials: L
authors.lastname: Frich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D018856:Cystitis, Interstitial / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction; D013577:Syndrome; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods*