If the ICN has helped you
HTML Rev.: Oct. 28, 1999
Created: Jan. 1995
and/or given you comfort
during those difficult nights,
we hope that you will become
a subscriber.
Diane Manhatten
Bev Laumann
Surgical Options
This option is considered only if an IC patient has failed all available treatments and the pain is severe. Most doctors are reluctant to operate because the outcome is unpredictable in individual patients-- some people continue to have symptoms even after the surgery. You can read more about the effectiveness of surgical studies in the treatment of IC in the ICN Research Library.Anyone considering surgery should discuss all the potential risks and benefits, potential side effects and potential complications with the surgeon and family. Surgery requires anesthesia, hospitalization, and weeks or months of recovery, and as the complexity of the procedure increases, so do the chances for complications and failure. The surgical techniques listed below are generalized summaries of each kind of procedure. Many variations on each type exist.
It may also be wise to talk to other IC patients who have had the procedure.
Transurethral fulguration and resection of ulcers.
Fulguration involves burning Hunner's ulcers using 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 treatments, done under anesthesia, use special instruments inserted into the bladder through a cystoscope. Laser surgery in the urinary tract should only be done by doctors who have the special training and expertise needed to perform the procedure.
Denervation
Denervation is a complicated procedure done by surgeons who have special training and expertise. Rarely used in the treatment of IC, it involves cutting some of the nerves to the bladder, interfering with pain signals. Many approaches and techniques are used, each of which has its own advantages and complications that should be discussed with the surgeon.
Augmentation
Augmentation makes the bladder larger, most often by adding a section of the patient's small intestine, a tube-like structure that absorbs and transports nutrients from food for use by the body. With this treatment, scarred, ulcerated and inflamed sections of the patient's bladder are removed, leaving only healthy tissue and the base of the bladder. A piece of the patient's small intestine is removed, reshaped, and attached to what remains of the bladder. After the incisions heal, the patient may be able to void normally.Even in carefully selected patients-those with small, contracted bladders--the pain, frequency, and urgency may remain or return after surgery and the patient may have additional problems with infections in the new bladder and difficulty absorbing nutrients from the shortened intestine. Some patients are incontinent while others cannot void at all and must insert a catheter into the urethra to empty urine from the bladder.
Bladder Removal (Cystectomy).
Different methods can be used to reroute urine once the bladder has been removed. In most cases, the ureters are attached to a piece of bowel that opens onto the skin of the abdomen, called a stoma. Urine empties through the stoma into a bag outside the body. This procedure is called a urostomy. Some urologists are using a technique that also requires a stoma but allows urine to be stored in a pouch inside the abdomen. At intervals throughout the day, the patient puts a catheter into the stoma and empties the pouch. Patients with either type of urostomy must use very clean, or sterile, steps to prevent infections in and around the stoma.With a third method, a new bladder is made from a piece of the patient's bowel (large intestine) and attached to the urethra in place of the removed bladder. After a time of healing, the patient may be able to empty the bladder by voiding at scheduled times or may insert a catheter into the urethra. Few surgeons have the special training and expertise needed to perform this procedure.
Even after total bladder removal, some patients still experience variable symptoms of IC. Therefore, the decision to undergo a cystectomy should only be undertaken after serious deliberation on the potential outcome.