Endoscopic ablation of Hunner’s lesions in interstitial cystitis patients

Authors

  • Ryan A. Payne Medical College of Wisconsin, Milwaukee, WI
  • R. Corey O’Connor Medical College of Wisconsin, Milwaukee, WI
  • Margarita Kressin Medical College of Wisconsin, Milwaukee, WI
  • Michael L. Guralnick Medical College of Wisconsin, Milwaukee, WI

DOI:

https://doi.org/10.5489/cuaj.1178

Abstract

Introduction: We report our experience with endoscopic ablation
of Hunner’s lesions in women with interstitial cystitis (IC).

Methods: A chart review was performed on 14 patients with IC
symptoms who were identified to have bladder lesions and underwent
endoscopic ablation. A Hunner’s lesion was identified as
an area of erythema that reproduced the patients’ pain when touched
by the cystoscope. Pathology reports were reviewed and improvement
in pain was used as the main outcome measure.
Results: Of the 14 patients, 12 had more than 50% symptomatic
improvement and 8 patients reported 100% improvement. Mean
improvement was 76%. In all patients who improved, the biopsy
specimen showed inflammatory cystitis, often with epithelial
denudation. Four patients had symptomatic recurrence, but all
had improvement after repeat ablation.

Conclusion: Endoscopic ablation of Hunner’s lesions improves symptoms
in IC patients. Recurrence of symptoms should prompt repeat
cystoscopy to identify recurrent lesions, as repeat ablation offers
symptomatic improvement.

Introduction : L’article fait état de notre expérience concernant
l’ablation endoscopique d’ulcères de Hunner chez des femmes
atteintes de cystite interstitielle (CI).

Méthodologie : On a mené un examen des dossiers de 14 patientes
présentant des symptômes de CI chez qui des lésions vésicales
avaient été observées et traitées par ablation endoscopique. Un
ulcère de Hunner était défini comme une zone d’érythème reproduisant
la douleur décrite par la patiente lorsque cette zone était
touchée à l’aide du cystoscope. Les rapports de pathologie ont
été examinés et la réduction de la douleur a été utilisée comme
principal critère d’évaluation.

Résultats : Sur les 14 patientes, 12 ont présenté une réduction supérieure
à 50 % des symptômes et 8 ont signalé une réduction de 100 %. Le
taux moyen de réduction était de 76 %. Chez toutes les patientes
ayant signalé une réduction des symptômes, l’échantillon de tissu
prélevé par biopsie montrait la présence de cystite inflammatoire,
souvent accompagnée de dénudation épithéliale. Quatre patientes
ont signalé une réapparition des symptômes, mais une nouvelle ablation
a permis de réduire encore une fois les symptômes.

Conclusion : L’ablation endoscopique des ulcères de Hunner entraîne
une réduction des symptômes en présence de CI. La réapparition
des symptômes devrait être prise en charge par une nouvelle cystoscopie
afin de repérer les nouvelles lésions; une nouvelle ablation
permet de soulager les symptômes.

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Author Biographies

Ryan A. Payne, Medical College of Wisconsin, Milwaukee, WI

R. Corey O’Connor, Medical College of Wisconsin, Milwaukee, WI

Margarita Kressin, Medical College of Wisconsin, Milwaukee, WI

Michael L. Guralnick, Medical College of Wisconsin, Milwaukee, WI

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How to Cite

Payne, R. A., O’Connor, R. C., Kressin, M., & Guralnick, M. L. (2013). Endoscopic ablation of Hunner’s lesions in interstitial cystitis patients. Canadian Urological Association Journal, 3(6), 473–7. https://doi.org/10.5489/cuaj.1178

Issue

Vol. 3 No. 6 (2009): CUAJ December

Section

Original Research

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