Treatment of interstitial cystitis with augmentation cystoplasty

Interstitial cystitis is common and difficult to manage. Many therapeutic modalities have been tried clinically, but none of them is particularly effective. Augmentation enterocystoplasty has been used to treat this disease with encouraging results. However, controversy exists regarding if supratrigonal cystectomy to remove diseased bladder has therapeutic advantage and what part of bowel produce better clinical results. We report on the results of augmentation cystoplasty in treatment of 13 patients with refractory interstitial cystitis who had failed multiple conservative therapies. There were 11 females and 2 males; age ranged from 29-69 years with a mean of 44 years. The patients have been followed for 6 to 64 months. The length of clinical symptomatology prior to the surgery ranged from 3-8 years. The methods of cystoplasty were as follows: sigmoid patch in 7 patients; tubular sigmoid in 3; ileum patch in 2, and ileocecal segment in 1. Two patients underwent supratrigonal cystectomy. The results were judged by the following criteria: pain, frequency, nocturia, bladder capacity (by CMG) and overall quality of life. Two patients with supratigonal cystectomy had recurrence of symptoms and were considered treatment failure; 1 patient subsequently underwent cystectomy and urinary diversion. Another patient with no excision of bladder has improvement of frequency, nocturia and increased bladder capacity, but persistent suprapubic pain. The remaining 10 patients have had complete relief of symptoms with significantly improved quality of life. The mean postoperative bladder capacity increased by 260cc. Three patients developed recurrent UTI's postoperatively one of whom is on intermittent catheterization. The rest of these patients are continent and void voluntarily. Bowel obstruction occurred in 1 patient which was resolved by redo of bowel anastomosis. Our study suggested that 1) augmentation cystoplasty is an effective treatment for refratory interstitial cystitis; 2) supratrigonal cystectomy did not seem to have therapeutic advantage; and 3) various bowel segments and methods of cystoplasty did not seem to affect the final results.