Prospective, Peripheral Nerve Surgical Approach to Treat Bladder Pain Syndrome/Interstitial Cystitis
Megan Gornet, MD1, Akash Chandawarkar, MD1, Amin Herati, MD1 and A. Lee Dellon, MD, PhD2, (1)Johns Hopkins University, Baltimore, MD, (2)Johns Hopkins University, Towson, MD
OBJECTIVE
For a select group of patients with interstitial cystitis, which is bladder pain syndrome (BPS/IC) of unknown etiology, resection of the ilioinguinal (II) and iliohypogastric (IH) nerves has been suggested as a treatment in patients who respond to nerve block of T12/L1 nerve roots. METHODS
A prospective cohort study was designed to test the hypothesis the BPS/IC can be caused by injury to the II and IH nerves. Inclusion Criteria: 1) previous lower abdominal wall surgery, typically endoscopic procedures, 2) a completely ÒnormalÓ Urological evaluation for other sources of bladder pain, 3) relief of bladder pain symptoms with anesthetic block of the T12/L1 nerve root. Exclusion Criteria: 1) absence of direct bladder surgery, 2) narcotic addiction, 3) medical conditions that would preclude elective surgery. Surgery: resection of the ilioinguinal and iliohypogastric nerves through lower quadrant incision. Evaluation: Completion of the validated OÕLeary-Sant ICS symptom indices (OSPI) and pelvic pain and urgency/frequency patient symptoms scale (PUF) scores were collected at specified intervals pre- and post-operatively. The cohort was composed of 5 females and 3 males. Ages ranged from 22 to 76 years with a median age of 46 years.
RESULTS
Eight patients were enrolled and completed the study. Median scores at pre-operative (OSPI 13.9, PUF 20.4) and one week time points (OSPI 5.9, PUF 11), as well as differences between pre-operative and ten month time points (OSPI 3.7, PUF 6) were all statistically significant (p= 0.008 and 0.009 at 1 week, and 0.007 and 0.008 at 10 months, for OSPI and PUF respectively). The mean difference in score from pre-operative to longest follow-up as measured by the OSPI was -14.4 (p < 0.001) and by PUF -10.3 (p < 0.001). All time points registered demonstrated improvement in pain scores. There were no surgical complications or adverse events. CONCLUSION
In patients with bladder pain syndrome who have had previous lower abdominal wall surgical interventions, and who have had referred pain to the bladder demonstrated by nerve block, II and IH nerve resection is an effective and durable treatment option.
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