Possible Surgeries for Interstitial Cystitis
Two procedures -- fulguration and resection of ulcers -- can be done with instruments inserted through the urethra. Fulguration involves burning Hunner's ulcers with electricity or a laser. When the area heals, the dead tissue and the ulcer fall off, leaving new, healthy tissue behind.
Resection involves cutting around and removing the ulcers. Both interstitial cystitis treatments are done under anesthesia and use special instruments inserted into the bladder through a cystoscope. Laser surgery in the urinary tract should be reserved for patients with Hunner's ulcers. and should be done only by doctors who have had special training and have the expertise needed to perform the procedure.
Another surgical option is augmentation, which makes the bladder larger. In most of these procedures, scarred, ulcerated, and inflamed sections of the bladder are removed, leaving only the base of the bladder and healthy tissue. A piece of the colon (large intestine) is then removed, reshaped, and attached to what remains of the bladder. After the incisions heal, you may have to urinate less often. The effect on pain varies greatly; interstitial cystitis can sometimes return on the segment of colon used to enlarge the bladder.
Even in carefully selected patients -- those with small, contracted bladders -- pain, frequency, and urgency may remain or return after interstitial cystitis surgery, and patients may have additional problems with infections in the new bladder and difficulty absorbing nutrients from the shortened colon. Some patients are incontinent, while others cannot void at all and must insert a catheter into the urethra to empty the bladder.
A surgical variation of transcutaneous electrical nerve stimulation (TENS) (see Interstitial Cystitis Treatment), called sacral nerve root stimulation, involves permanent implantation of electrodes and a unit emitting continuous electrical pulses. Studies of this experimental surgery are now under way in interstitial cystitis clinical studies.