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For IC/BPS Patients Undergoing Bladder Removal Surgery, Removal of Urethra May Not Be Necessary

Yang TX, Luo DY, Li H, Wang KJ, Shen H. Is Urethrectomy Necessary during Cystectomy in Patients with Interstitial Cystitis/Bladder Pain Syndrome? Urology. 2016 Jul 13. pii: S0090-4295(16)30394-6. doi: 10.1016/j.urology.2016.07.003. [Epub ahead of print]
Cystectomy, or surgical removal of the bladder, is a procedure that some physicians may recommend for patients with interstitial cystitis/bladder pain syndrome (IC/BPS) that is persistent despite more conservative treatments. In one recent review of published studies, the procedure was effective in 80% of IC/BPS cases. One somewhat controversial question is whether surgeons should also remove the urethra as part of the procedure. For example, in one published report, two patients who had a cystectomy but no urethrectomy both complained of persistent pain afterward; based on those observations, the authors suggested that removal of the urethra should be part of the procedure for IC/BPS patients who will undergo cystectomy. Now, however, a more recent published report suggests that a urethrectomy is not necessary. To assess whether the additional procedure is needed, the authors of this report reviewed cases of 18 women with persistent IC/BPS treated between 2007 and 2014 with cystectomy or cystectomy plus urethrectomy. They found that women who received urethrectomy were no more likely to subsequently report pain vs those who did not. Moreover, they had longer operation times, and a longer stay in the hospital after the procedure, compared to women who underwent cystectomy only. Overall, women reported decreased frequency of urination after the procedures, which also led to improvements in mental condition and social function. Based on these findings, the investigators said that urethrectomy is probably not routinely needed; however, they added that larger, longer-term studies should be conducted to gain more conclusive insights.