Interstitial Cystitis (cont.)
For those whose symptoms are severe and who do not respond to other IC treatments, bladder surgery may be considered. However, surgery does not necessarily improve symptoms. Several approaches and techniques have been used.
- Fulguration: This procedure involves burning ulcers, if present, with a laser by inserting instruments into the bladder through the urethra.
- Resection: This procedure involves cutting and removing the ulcer, if present, by inserting instruments into the bladder through the urethra.
- Augmentation: In this procedure, the scarred and ulcerated part of the bladder is removed and a piece of intestine (either large or small) is attached to the bladder. However, IC can sometimes recur on the segment of bowel used to augment the bladder. After the procedure, the person may have additional problems such as infections in the newly created bladder, incontinence, or they may require a catheter to empty the bladder.
- Cystectomy (bladder removal): After removal of the bladder, different procedures can be used to reroute the urine. Still, IC symptoms remain in as many as 50% of the patients after major surgery such as cystectomy. Detailed and honest counseling is imperative in these patients.
- In most people undergoing cystectomy, ureters (tubes that carry urine from each kidney to the bladder) are attached to a piece of intestine that opens onto the skin of the abdomen. Urine empties through the stoma (opening) into a bag outside the body. This procedure is commonly referred to as an ileal conduit.
- Some surgeons use a technique that allows urine to be stored in a pouch inside the abdomen, which can be emptied at intervals using a catheter. However, both this procedure and the ileal conduit have a potential for complications like kidney infection or kidney stones.
- Alternatively, a new bladder can be created from a piece of bowel and attached to the urethra. After healing, the person may be able to empty the bladder by voiding at regular intervals or by inserting a catheter or voiding spontaneously. Surgeons performing this procedure require special training and expertise.
- Strangely, even after total bladder removal, some people may still experience symptoms; therefore, surgery should only be considered after all alternative treatments have failed.
George Lazarou, MD, FACOG
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