Surgical Procedures

For people with interstitial cystitis/bladder pain syndrome (IC/BPS), the term surgery may be used to describe tests to diagnose IC/BPS, as well as treatment options. One surgical procedure, called cystoscopy with hydrodistention, may be used to both diagnosis and treat IC/BPS. Surgery may also be performed to implant an electrical nerve stimulator to help relieve IC/BPS symptoms. Otherwise, with the exception of laser surgery for Hunner’s ulcers, bladder surgery option is generally considered a treatment of last resort. Only a urologist experienced in treating IC/BPS can advise you on the appropriateness of surgery for your particular situation.

Questions to Ask Your Doctor before Surgery

Before surgery, learn about the procedure and what to expect:

• Are there other forms of treatments to try before considering surgery, such as pain management techniques or pain medicines?
• What are the chances that I will still have IC/BPS symptoms after this surgery?
• How long will the surgery take, how long will my hospital stay be, and how long is the recovery period?
• How many patients have you performed this procedure on, and how are they doing?
• What are the known complications of the procedure?
• Is there a chance that I will have to self-catheterize after surgery? Will this be temporary or permanent?
• How will my bowel function be affected by this surgery?
• Will my kidneys be affected by the surgery?
• How will my activities be restricted after surgery?
• If I continue to have pain, how can it be treated?
• What conditions may require further surgery, and what are the chances I will need it?
• How do I prepare myself for surgery?
• Is psychological counseling recommended for patients considering bladder surgery?

Laser Surgery

Laser surgery has been used successfully to treat Hunner’s ulcers (or patches), which are present in 5 to 10 percent of IC/BPS patients. A type of transurethral fulguration, laser surgery works by destroying a layer of tissue using an electrical current or laser beam. This treatment may provide relief of symptoms caused by these ulcers; however symptoms can recur over time, necessitating additional laser surgery. No other uses of lasers for treating IC/BPS have been clinically proven; therefore, laser surgery should be reserved for the ulcerative form of IC/BPS only.

Other Types of Bladder Surgery

Bladder surgery is invasive and irreversible. Many IC/BPS patients who choose to have surgery may not improve. Some patients do worse after surgery. Surgery should be considered only when all other treatment choices have failed. Talk with your doctor before the procedure. Learn what to expect. Ask about potential complications such as infections, metabolic disturbances, urolithiasis (stone formation), perforation, increased mucus production, recurrence of IC/BPS, and kidney damage (over a period of 15 to 20 years).

Urinary diversion: There are various types of urinary diversions. The bladder may be removed or left in place. In one urinary diversion procedure, the surgeon fashions a tube or conduit from a short section of bowel and places the ureters (which carry urine from the kidneys to the bladder) in this conduit. The conduit is then diverted to an opening in the abdomen called a stoma, through which urine is allowed to drain continually into an external collection bag. Urinary diversion eliminates frequency, but may not always result in elimination of pain. Another option is to construct an internal pouch (known as a Koch, Florida, or Indiana pouch) from a bowel segment and place it inside the abdomen. The urine is emptied from the pouch by self-catheterization four to six times each day.

Orthotopic diversion: For this procedure, the bladder is removed and a new bladder, constructed from a bowel segment, is connected to the urethra, replacing the removed bladder. Patients then void through the normal urethral channel without the necessity of a catheter or bag. The development of urinary incontinence is one possible drawback of this procedure.

Augmentation cystoplasty: This surgery removes part or most of the bladder and replaces it with a section of the patient’s bowel to form a new bladder. Urine continues to be stored in the bladder and emptied through the urethra. Following this procedure, some patients will continue to experience symptoms of frequency, urgency, and pain. IC/BPS has also been reported to recur in the augmented bowel segment of these newly fashioned bladders. Some patients who undergo a total cystectomy (bladder removal) still experience pelvic pain (phantom pain)—indicating that neurologic mechanisms are an important aspect of IC/BPS that is not yet understood. Because of these drawbacks, this procedure is seldom performed.