|
|
|
|
This Fact Sheet is designed to present an overview of surgical procedures that interstitial cystitis (IC) patients may choose to consider. Bladder surgery (excluding diagnostic procedures) is generally considered the treatment of last resort by IC patients and their doctors. The obvious reason is that surgery is invasive and irreversible, but in addition, many patients who choose to have surgery may not improve. Some may, in fact, do worse. Potential complications from these procedures also need to be considered. Researchers have pointed out that with an ever-enlarging array of treatment options available to the IC patient, surgery should be considered only when all other choices have failed. Only a urologist experienced in treating IC can advise you as to the appropriateness of surgery for your particular situation.
Augmentation Cystoplasty:a procedure in which part or most of the bladder is surgically removed and replaced with a section of the patient’s bowel, thus forming 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. Some may be unable to void without self-catheterization. IC can recur in the bowel segment of the newly constructed bladder. Because of these drawbacks, this procedure is seldom performed.
Urinary Diversion: With the bladder either removed or left in place, a tube or conduit is fashioned from a short section of bowel, and the ureters (which carry urine from the kidneys to the bladder) are placed in this conduit. This 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.
In this type of diversion, with the bladder either removed or left in place, an internal pouch (known as a Koch, Florida, or Indiana pouch) is constructed from a bowel segment and placed inside the abdomen. The urine is emptied from the pouch by self-catheterization four to six times each day.
Orthotopic Diversion: This relatively new procedure is being performed in selected surgical centers. This is a type of diversion in which 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.
Possible complications of these procedures can include eventual kidney damage over a period of 15-20 years. Additionally, some research has shown that when bowel tissues are in contact with urine, multiple complications can result, including infections, metabolic disturbances, urolithiasis (stone formation), perforation, and increased mucus production, as well as recurrence of IC on the bowel tissue.
A 1998 study reviewed the cases of 106 IC surgery patients. This study indicated that many augmentation patients continued to have urgency and frequency, and some were unable to void on their own, necessitating self-catheterization, which was often difficult. IC has also been reported to recur in the augmented bowel segment of these newly fashioned bladders. Some patients who undergo total cystectomies (bladder removal) still experience pelvic pain (phantom pain), indicating that neurologic mechanisms are an important aspect of IC not yet understood.
Most of the current available literature concludes that surgery should be reserved as the treatment of last resort for those patients whose severe symptoms are unresponsive to other therapies.
Laser surgery is a treatment that has received a significant amount of recent publicity in the urologic community. Laser surgery, one type of transurethral fulguration (destruction of a layer of tissue using an electrical current or laser beam) has been successfully used to treat Hunner’s ulcers (or patches), present in 5 to 10 percent of IC patients. No other uses for treating IC with lasers have been clinically proven; therefore laser surgery should be reserved for the ulcerative form of IC only.
This treatment may provide relief of symptoms caused by these ulcers, however symptoms can recur over time, necessitating additional laser surgery.
Other surgical procedures that IC patients may undergo include cystoscopy with hydrodistention under regional or general anesthesia (a diagnostic procedure with potential therapeutic benefits); and the surgical implantation of symptom management devices, such as sacral nerve root stimulators. These procedures are discussed in depth in separate fact sheets published by the ICA and available through our ICA Resource Materials Guide or on our Website at www.ichelp.org.
The ICA will make Telephone Support Lists available to anyone who is contemplating bladder surgery or laser surgery. Please contact the ICA at the phone number below if you are contemplating surgery and would like to speak to someone who has already had the procedure you are considering.
Some Questions to Ask Your Doctor when Considering Surgery
- What are the known complications of the procedure?
- What is the specific condition of my bladder: capacity, presence of ulcers, fibrosis?
- Are there other treatments I should try, including pain management techniques or pain medication, before I consider surgery?
- Should I have psychological counseling before I decide on surgery? How do I prepare myself for surgery?
- What are the chances I will still have IC symptoms after this surgery?
- If I continue to have pain, how can it be treated?
- Is there a chance 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 after the surgery?
- How long will the surgery take, how long will my hospital stay be, and how long is the recovery period?
- How will my activities be restricted after surgery?
- What conditions require further surgery and what are the chances I will need it?
- How many patients have you performed this specific procedure on, and how are they doing?
- NKUDIC brochure
- ICA, “American Urological Association Annual Meeting 1999 Interstitial Cystitis Poster Session Abstract Summaries,” edited by JS Smith, December 1999.
- Pontari, M, Hanno, P, and Wein, A, Logical and Systematic Approach to the Evaluation and Management of Patients Suspected of Having Interstitial Cystitis, Urology: Interstitial Cystitis Supplement to May 1997, Alan J. Wein, MD & Philip M Hanno, MD, Editors, pp. 114-120
- Shanberg AM, Malloy T, Use of lasers in interstitial cystitis, in Sant G, Interstitial Cystitis, Lippincott-Raven 1997:215-17.
- Hohenfeller M, et al, Surgical treatment of interstitial cystitis, in Sant G, Interstitial Cystitis, Lippincott-Raven 1997:223-33.
|
|
|