Open Access

ARTICLE

Assessment of patient outcomes following submucosal injection of triamcinolone for treatment of Hunner’s ulcer subtype interstitial cystitis

Michael Cox¹, John J. Klutke², Carl G. Klutke¹

1 Division of Urology, Washington University, St. Louis, Missouri, USA
2 Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Address correspondence to Dr. Carl Klutke, Division of Urology, Washington University School of Medicine, 1040 N. Mason Road, Suite 122, St. Louis, MO 63141 USA

Canadian Journal of Urology 2009, 16(2), 4536-4540.

Abstract

Introduction and objective: Hunner's ulcer subtype interstitial cystitis (IC) is characterized by the presence of circumscribed inflammatory ulcerations in the bladder wall identified during endoscopic examination of individuals with irritative voiding symptoms and pelvic pain. We present our experience with management of this subgroup with intralesional submucosal injection of corticosteroid.
Methods: Prospective analysis of patients presenting with Hunner's ulcer subtype IC was performed between November 2006 and April 2008. All patients underwent flexible cystoscopy and biopsy confirming the presence of Hunner's ulcer(s). Under general anesthesia, 10 ml of triamcinolone acetonide (40 mg/ml) was injected in 0.5 ml aliquots into the submucosal space of the center and periphery of ulcer(s) using an endoscopic needle. Patient symptoms and quality of life were assessed using two validated questionnaires, the International Prostate Symptom Score (IPSS) and the Pelvic Pain and Urgency/Frequency (PUF) symptom scale. Each questionnaire was administered prior to therapy and 4 weeks postoperatively. The postoperative interview included the Patient Global Impression of Change (PGIC).
Results: Thirty patients with Hunner's ulcer subtype IC underwent endoscopic submucosal injection of triamcinolone. The mean preoperative and postoperative IPSS were 21.1 and 11.3, respectively. The mean preoperative and postoperative PUF scores were 20.0 and 11.0, respectively. PGIC assessment revealed 21 of 30 patients (70%) very much improved. No perioperative complications were noted.
Conclusion: In Hunner's ulcer IC, submucosal injection of triamcinolone is well tolerated. This treatment offers significant improvement in symptoms and quality of life based on responses from validated questionnaires administered before and after therapy.

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