Hunner’s Lesions Treatment

What are Hunner’s Lesions?

Roughly 5 to 10% of patients have Hunner’s lesions on their bladder wall. These areas  often extremely painful, areas of inflammation in the bladder wall. Considered one of the great mysteries of IC, research studies from Europe found active virus (polyoma, Epstein Barr) in the urine of patients with lesions, suggesting that they could be chronic viral infections of the bladder wall. Yet other studies have suggested that neuroinflammation could be an underlying cause.

Hunner’s lesions  do NOT generally respond to traditional oral medications and/or bladder instillations, requiring either fulguration or steroid therapy.  Treatment is performed during a hydrodistention with cystoscopy at the time they are diagnosed. If lesions are not treated at that time, another hydrodistention will be required for treatment.

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.

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 lesion can recur in the area, resulting in pain can returning within three to nine months. Additional treatment may be required. Fulguration can also cause 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.

3. Hyperbaric Oxygen Therapy HOT

Hyperbaric oxygen therapy (aka decompression therapy) is most well known for saving the lives of scuba divers. The patient is placed in a pressurized chamber where they breathe 100% oxygen for a period of time. The increased pressure allows the lungs to absorb more oxygen than they would at normal pressure. The blood stream then delivers the oxygen throughout the body where it can help fight infection, stimulate growth factors and stem cells and enhance healing.

Several studies have shown that HOT therapy can be helpful for IC/BPS.(4) Researchers in Japan treated two patients with 20 sessions of hyperbaric therapy, reporting that Hunner’s lesions disappeared completely AND pain and frequency were improved. That same time followed 11 patients (eight with lesions and 3 without) who had not responded to therapies. They received treatment for 60 minutes per day, 5 times per week for 2 to 4 weeks. After ten sessions, seven patients showed significant improvements in their symptoms. The researchers suggest that HOT therapy accelerates the healing phase of ulcerative IC/BPS. An American study found yet more success with 83% of patients reporting improvement in their lesions and 66% showing long term success at six months.

It is now available at specialty centers throughout the USA provided that your urologist is familiar with the technology and willing to try it.

4. Surgical Resection Of The Lesion

On 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.

References:

  1. Hillelsohn J, et al. Fulguration for Hunner ulcers: long-term clinical outcomes. J Urol. 2012 Dec;188(6):2238-41.
  2. 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.
  3. Oliver J, et al. Triamcinolone Injection vs. Fulguration for the treatment of Hunner’s Ulcer Type Interstitial Cystitis. ICS Annual Meeting Poster #555
  4. Osborne J. Hyperbaric Oxygen Therapy: A treatment used for decompression sickness may also help with lesions. The IC Optimist. Late Winter – Early Spring 2019. P14-15.

Author: Jill Osborne
Revised: 07/6/22