When behavioral changes, oral medications, and bladder instillations have not provided enough relief, certain medical procedures may be considered. These interventions range from relatively simple outpatient techniques to more advanced treatments that involve implanted devices. Below is an overview of the procedural options currently recognized in the AUA’s 2022 clinical guideline for IC/BPS.

This procedure involves gently stretching the bladder with fluid while the patient is under anesthesia. The stretching itself may provide temporary symptom relief for some patients, though benefits often fade over several months.

A temporary symptom flare in the days following the procedure is common but usually short-lived. Repeated procedures over time have not been shown to damage the bladder or reduce its capacity. The AUA specifically warns against high-pressure or long-duration distension, as this carries a risk of serious complications, such as bladder rupture, without added benefit.

Hunner lesions are inflamed, ulcer-like areas on the bladder wall found in a subset of IC/BPS patients, most commonly those over age 50. When identified, the AUA recommends they be treated directly. This is one of the strongest recommendations in the guideline.

Two main treatment approaches:

  • Fulguration: Using electrical or laser energy to destroy the inflamed tissue.
  • Triamcinolone injection: Injecting a steroid directly into and around the lesion through the cystoscope.

What to expect:

  • Many patients experience complete or near-complete pain relief after treatment.
  • Relief typically lasts months to over a year before symptoms gradually return.
  • Retreatment is normal and expected; the procedures remain effective when repeated.
  • Complications are rare and generally minor.

For patients whose lesions keep returning despite repeated treatments, oral cyclosporine A may be considered as an additional therapy.

Botox can be injected into the bladder wall via a cystoscope to block nerve signals that contribute to pain, urgency, and muscle overactivity. It is typically considered after other treatments have been tried.

Key points:

  • Many patients experience improvement in pain, urgency, and quality of life.
  • Effects last several months before wearing off; injections can be repeated.
  • Repeated treatments remain effective and may produce cumulative benefits.

Important risks:

  • Some patients have difficulty emptying the bladder afterward and may need to self-catheterize (inserting a thin tube to drain urine) for weeks or months.
  • Temporary burning with urination and urinary tract infections are also possible.
  • Patients must be willing to accept the possibility of self-catheterization before choosing this option.

This procedure is not appropriate for patients who cannot tolerate catheterization or who already have signs of incomplete bladder emptying.

Neuromodulation uses mild electrical impulses to change how nerves communicate with the bladder. It may be considered when other treatments have failed.

How it works:

  • A trial period with a temporary electrode is used to test whether the stimulation helps.
  • If successful, a small permanent device (similar to a pacemaker) is implanted under the skin.
  • Electrodes are placed near the sacral nerves (lower back) or pudendal nerves (pelvic floor).

Effectiveness:

  • Many patients with permanent implants report sustained benefit over 5+ years.
  • Improvements are seen in urgency, frequency, nighttime urination, and bladder capacity.
  • Some patients can reduce or stop other IC/BPS medications.

Limitations:

  • Most effective for urgency and frequency, less reliably helpful for pain specifically.
  • Revision procedures (battery replacement, lead adjustments) are fairly common over time.
  • A small percentage of patients eventually have the device removed.
  • Not currently FDA-approved specifically for IC/BPS, though many patients qualify under its approved indication for refractory urgency/frequency.

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