Interstitial cystitis (IC) is a chronic condition characterized by bladder and/or pelvic pain, often accompanied by lower urinary tract symptoms. Patients with Hunner type IC tend to have more severe and refractory symptoms than those with non-Hunner type, and while surgery is a common treatment approach, the optimal extent of HLs treatment has not been standardized. In the current study, we aimed to evaluate the pattern of HLs recurrence and to identify predictive factors in patients who underwent transurethral resection and cauterization (TUR-C) for the treatment of Hunner type IC.

This study was a retrospective analysis of data from patients with IC who underwent transurethral resection and cauterization (TUR-C) of HLs between October 2011 and December 2017. The location and extent of lesions was documented according to a bladder map, which divides the bladder wall into 22 zones:the trigone, posterior wall (P1-9), lateral wall (R1-3 and L1-3), and dome (D1-6). Symptoms were evaluated using with the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF), O’Leary-Sant Interstitial Cystitis Symptom Index (ICI), and Visual Analogue Scale (VAS). Patients attended follow-up visits every 3 months; cystoscopy was performed immediately in patients with aggravated symptoms. Recurrence was defined as a VAS score ≥ 4 and HLs recurrence on cystoscopy.

A total of 91 patients were enrolled (25 male, 66 female): median follow-up was 30.6 months. HLs recurrence occurred in 101 sites (53 patients), 21.8% in the previous TUR-C site, 18.8% de novo, and 59.4% at both previous and de novo sites. The recurrence rate was approximately 12.7%, 40% and 55.2% at 6, 12, and 18 months, respectively. HLs recurred in 53 patients, 51 of whom underwent a second TUR-C. Second recurrence occurred in 54.9% (28/51) after the second treatment at a mean time of 16.3 months after surgery. A higher PUF bother score was the only predictive factor of recurrence (OR: 1.142, 95% CI: 1.016-1.284, p = 0.026), with a cut-off value of 7.5 (sensitivity: 67.9%, specificity: 62.5%). In case of late recurrence (>18 months), there was no predictive factor.

The HLs recurrence pattern was unpredictable, involving both previous TUR-C and de novo areas. Severe baseline symptoms, higher PUF bother scores tend to be associated with HL recurrence. Although define HLs resection with a sufficient margin may lead to better surgical outcomes, further investigation of strategies to restore the entire bladder wall may be required to further improve therapeutic efficacy.

The HLs recurrence pattern was unpredictable, involving both previous TUR-C and de novo areas. More accurately defining the HLs resection margin may lead to better surgical outcomes but this remains to be proven.

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