Hunner’s Lesions Treatment
Hunner’s ulcers or lesions are profound, often extremely painful, areas of inflammation in the bladder wall. They do not generally respond to traditional oral medications and/or bladder instillations, requiring more aggressive therapy. Hunner’s lesion treatment occurs during the hydrodistention procedure which discovered them. Make sure that you discuss with your urologist your treatment options if they do find lesions so that they can be treated promptly and as early as possible. Otherwise, you may need another procedure to treat them correctly!
1. Fulguration & Laser Therapy (aka Cauterization)
Fulguration uses heat to burn the area of the lesion or ulcer while laser therapy uses an electric current or laser beam. This then destroys the local nerves in the area which causes a decrease in the substances which trigger the inflammation. As a Step Three recommendation, most patients will have first tried all of the suggestions in Step One and Step Two.
More than 90% of patients report atleast a 50% improvement in pain after the procedure with some lasting for years.(1) For other patients, however, the Hunner’s ulcer can recur in the area, resulting in pain can returning within three to nine months. Additional treatment may be required. Fulguration can also cause some bladder wall scarring that could decrease bladder capacity over time.
Fulguration or laser therapy are always performed under general or spinal anesthesia. An anesthetic solution is often placed in the bladder at the end of the procedure to numb the bladder and reduce post-operative pain.
2. Triamcinolone Injection
Researchers have found that the submucosal injection of triamcinolone into the center and periphery of Hunner’s ulcers to improve patient symptoms and discomfort. One study found that 70% of those patients who received triamcinolone treatment had a significant improvement in their symptoms.(2) Additional studies found the results comparable to those found in fulguration studies.(3) This procedure does not leave scarring on the bladder wall thus is usually tried before more aggressive cauterization.
LiRIS is a medical device that delivers lidocaine into the bladder for a two week period. In their first study for pain, the researchers found that lesions also responded favorably to treatment. In 2015, Allergan bought the LiRIS device from Taris Biomedical. They released the first round of “proof of concept” research at the 2016 AUA meeting which showed improvements in lesion number, severity, and size by day 14. Corresponding with the lesion changes, the women benefited with reductions in pain, voiding frequency, and other IC-related symptoms and problems that were sustained during the post-treatment follow-up.
Dr. Ken Peters – Beaumont Urology Chairman
Principle Investigator Ken Peters said “Previously, the only management options available for IC patients with Hunner’s lesions has been surgery to cauterize the lesions or injection of the lesions with a steroid. Although this study includes a very small population, we are excited about the potential of the lidocaine-releasing system for treating IC in patients with and without Hunner’s lesions. Now, we are looking forward to the results from ongoing phase II double-blind randomized trials,” said Dr. Peters, professor and chair in urology, Oakland University William Beaumont School of Medicine, Rochester, MI. (4)
Sadly, Allergan “deprioritized” LiRIS and suspended all further researcher in in 2018.
4. Surgical Resection Of The Lesion
In rare occasions, urologists may choose to remove the lesion from the bladder wall via a resection procedure. The challenge with resection is that it is major surgery that can leave a smaller, less flexible bladder wall. Bladder capacity is reduced as well. The American Urology Association does not recommend surgical resection for the treatment of ulcers/lesions.
- Hillelsohn J, et al. Fulguration for Hunner ulcers: long-term clinical outcomes. J Urol. 2012 Dec;188(6):2238-41.
- Cox M, et al. Assessment of patient outcomes following submucosal injection of triamcinolone for treatment of Hunner’s ulcer subtype interstitial cystitis. Can J Urol. 2009 Apr;16(2):4536-40.
- Oliver J, et al. Triamcinolone Injection vs. Fulguration for the treatment of Hunner’s Ulcer Type Interstitial Cystitis. ICS Annual Meeting Poster #555
- Guttman Krater C. Device efficacious for treating IC with Hunner’s lesions. Urology Times. October 1, 2016
Author: Jill Osborne