潰瘍型間質性膀胱炎的手術治療結果
江元宏、郭漢崇
花蓮慈濟醫院 泌尿科
Results of the surgical treatments of ulcer type interstitial cystitis
 
Yuan-Hong Jiang, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University Hualien, Taiwan
 
Purpose: The pathophysiology of ulcer type interstitial cystitis (IC) is still unclear. Various medical and surgical therapies have been used without a common consensus. This study aimed to evaluate the surgical outcomes of ulcer type IC.
 
Materials and Methods: We retrospectively collected 14 ulcer type IC female patients, who were diagnosed during cystoscopic hydrodistension, and their medical records were reviewed. The severity and duration of symptoms, and self-assessed surgical responses were presented with descriptive statistics.
 
Results: The mean age on the development of symptoms and on the diagnosis were 56.0 ± 8.4 and 59.1 ± 7.0 years, respectively, with a mean VAS pain score 8.2 ± 1.4. Ten (71.4%) patients received intravesical Botox (botulinum toxin-A) injection with 50% (5 of 10) response rate of pain relief; however, in 4 of 5 patients, their pain increased again after 2.75 ± 0.38 months. All patients received electrocauterization with 85.7% (12 of 14) response rate; however, in 11 of 12 patients, their pain increased again after 3.09 ±1.75 months. Five patients with poor electrocauterization outcome received simple partial cystectomy; however, four patients (80%) did not satisfy the surgical outcome due to rapid relapse of pain after 1.75 ± 0.75 months. Two of these 4 patients subsequently received extensive (supratrigonal) partial cystectomy concurrent with augmentation enterocystoplasty (AE). Finally, total 6 patients received extensive (supratrigonal) partial cystectomy concurrent with AE, and all patients (100%) satisfied with the surgeries due to the significant relief of pain and symptoms during a follow-up of 7.67± 3.22 months.
 
Conclusions: For ulcer type IC patients, electrocauteterization as a treatment option is effective but with short term efficacy and a high relapse rate. Simple partial cystectomy is not feasible in these patients. Extensive partial cystectomy concurrent with AE can effectively relieve pain and symptoms with high satisfaction.
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    台灣泌尿科醫學會
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    2015-06-18 00:59:00
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    2015-06-18 01:02:49
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