For interstitial cystitis (IC) with Hunner lesions, transurethral resection or coagulation (TUR/TUC) is recommended in AUA Guideline. It causes an obvious effect, although recurrence is highly possible. As bladder contraction is one of the troublesome problems after repeated TUR and TUC, even experts believe that repeated surgeries should not to be done to avoid bladder contraction. However, in my experience, repeated hydrodistension with TUC did not cause bladder contraction. We evaluated the effects and the side effects of repeated hydrodistension with TUC for IC with Hunner lesions.

Forty-four IC patients with Hunner lesions underwent a total of 119 operations, from July 2005 to Sept. 2017. Forty-two were women. There were 20 patients who underwent surgery twice (group S), 17 patients at 3 times (group T) and 7 patients at 4 times (group F).
The maximum bladder capacity during hydrodistension was measured.
Patients were routinely followed up at months 2, 6, 12 after operation. Efficacy was assessed at these time points by O’Leary Sant symptom and problem scores, pain intensity on 0 to 10-point VAS, and 4 day’s frequency volume chart (FVC).

The maximum bladder capacity during hydrodistension of group S, T, F were 431±120ml, 440±142ml and 372±142ml, respectively. There were no significant differences between 3 groups.
Preoperative average 24-hour urinary frequency was 24.3  24.9 in the S group, 15.4  5.7 in the T group and 16.7  8.1 in the F group. 
Preoperative average voided volume (AVV) was 96  42 ml in the S group, 121  48 ml in the T group (p<0.01) and 125  49 ml in the F group (p<0.01). There was a significant difference between the T or F group and S group. Preoperative maximum voided volume (MVV) was 165  65 ml in the S group, 176  64 ml in the T group and 125  49 ml in the F group. There were no significant differences between 3 groups. 
Preoperative ICSI, ICPI and pain score on VAS were 15.5, 13, 7.5 in the S group, 13.2, 10.6, 6.2 in the T group and 13, 9.4, 6.4 in the F group. There was a significant difference between the T or F group and S group.
At 2 months after surgery, there were no significant differences in frequency, AVV and MVV between three groups. ICSI, ICPI and pain score on VAS were 6.9, 4.3, 2.6 in the S group, 5.4, 2.9, 1.2 in the T group and 4.6, 2.1, 1.0 in the F group. Pain score in the T group and ICSI, ICPI and pain score in the F group significantly decreased compared to the S group. There was no significant difference between T and F group.
At 6 months after surgery, frequency, AVV and MVV in the T group increased significantly compared to the S group. ICSI, ICPI in the T and F group decreased significantly compared to the S group. There was no significant difference in pain score between 3 groups. 
At 12 months after surgery, AVV in the T and F group, and MVV in the T group increased significantly compared to the S group. ICSI in the T and F group, and ICPI and pain score in the T group decreased significantly compared to the S group.

Repeated surgeries contributed to improvement of symptoms and bladder capasity. They did not cause worsening of symptoms and did not reduce bladder capacity.

Repeated hydrodistension with TUC for recurrence IC with Hunner lesions  improves symptoms. It  was not a direct cause of bladder contractility and it rather resulted in increased bladder capacity. However, a coagulation that is too deep may give the muscle layer damage and cause the contraction of the muscle.