title: Hydrodistension with or without fulguration of hunner lesions for interstitial cystitis: Long-term outcomes and prognostic predictors.
abstract: Hydrodistension of the bladder, with optional fulguration of Hunner lesions, is one of the recommended therapies for interstitial cystitis (IC). The aims of this study are to evaluate long-term outcomes of hydrodistension and identify outcome predictors.
  
  
  
  The study cohort was 191 newly diagnosed IC patients (155 women and 36 men) who underwent hydrodistension with fulguration of Hunner lesions if detected between 2007 and 2013 at our institution. The primary outcome was therapeutic failure, which was defined as repeat hydrodistension, bladder instillation therapy, or narcotic use for pain control. Clinical features, including comorbidities and endoscopic findings, were analyzed along with the outcome.
  
  
  
  The cohort comprised 126 patients of Hunner type IC and 65 patients of non-Hunner type IC. The mean time to therapeutic failure was 28.5 months in Hunner type IC and 25.2 months in non-Hunner type IC. The therapeutic failure rate was higher in non-Hunner type IC at 17.3 months; however, the long-term outcomes reversed thereafter. The mean time to therapeutic failure was shorter in patients with lumbar spinal stenosis (LSS) or irritable bowel syndrome (IBS). Multivariate analysis identified LSS as a predictor for failure in Hunner type IC and non-Hunner type IC (HR = 18.8, P = 0.001; HR = 3.8, P = 0.028, respectively) and IBS in non-Hunner type IC (HR = 18.0, P = 0.008).
  
  
  
  Bladder hydrodistension, with fulguration of the Hunner lesions, improved IC symptoms. The outcome was worse in non-Hunner type IC shortly after hydrodistension but eventually comparable across the two types. Concomitant LSS and IBS were predictors for poor outcome. Neurourol. Urodynam. 35:965-969, 2016. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan. niimia-uro@h.u-tokyo.ac.jp.
authors.forename: Aya
authors.initials: A
authors.lastname: Niimi
authors.affiliation: Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan.|Department of Urology, Mitsui Memorial Hospital, Chiyoda-ku, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Nomiya
authors.affiliation: Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan.|Department of Urology, Japan Red Cross Medical Centre, Shibuya-ku, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Urology, Tokyo Teishin Hospital, Chiyoda-ku, Tokyo, Japan.
authors.forename: Motofumi
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujimura
authors.affiliation: Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuhara
authors.affiliation: Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Haruki
authors.initials: H
authors.lastname: Kume
authors.affiliation: Department of Continence Medicine, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Igawa
authors.affiliation: Department of Urology, Graduate School of Medical, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018856:Cystitis, Interstitial / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D011379:Prognosis; D012307:Risk Factors; D013130:Spinal Stenosis / Q000150:complications; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D009294:Narcotics
keywords: fulguration; hydrodistension; interstitial cystitis; long-term outcomes; lumbar spinal stenosis