한빛사 논문
Kwang Jin Koa, Won Jin Chob, Young-Suk Leec, Joongwon Choid, Hye Jin Byund, Kyu-Sung Leed,e,*
a Department of Urology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
b Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
c Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
d Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
e Division of Medical Device, Clinical Trial Center, Samsung Medical Center, Seoul, Korea
*Corresponding author : Kyu-Sung Lee
Abstract
Background
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by chronic pelvic pain related to the bladder with no effective treatment options.
Objective
To evaluate the efficacy and safety of transurethral resection (TUR) and transurethral coagulation (TUC) as treatments for Hunner lesion (HL) in IC/BPS.
Design, setting, and participants
A single-center, prospective, randomized controlled trial involving 126 patients with HL in IC/BPS.
Intervention
TUR or TUC.
Outcome measurements and statistical analysis
Primary outcome was recurrence-free time after surgery. Secondary outcomes included change of the number of frequency, nocturia, urgency episodes in voiding diaries, O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), pelvic pain and urgency/frequency (PUF) symptom scale, and visual analog scale (VAS) for pain and risk factors for recurrence.
Results and limitations
There were no differences in the recurrence-free time between treatment groups, a difference of 12.2 mo (95% confidence interval [CI], 11.1–17.6) for TUR, and a difference of 11.5 mo (95% CI, 9.03–16.1; p = 0.735) for TUC. No difference was found in decreased mean daytime frequency, nocturia, urgency episodes, ICSI, ICPI, PUF symptom scale, and VAS for pain between both groups over 12 mo. Regardless of treatment types, there were significant improvements in all symptom questionnaires and pain compared with baseline (all, p < 0.05). Treatment type (TUR or TUC), age, sex, previous history of hydrodistension, and number of HLs did not affect recurrence. Incidence of bladder injury was higher in the TUR group (7.9%) than in the TUC group (3.4%).
Conclusions
There was no difference in the recurrence-free time and effect on urinary symptoms, including pain between TUC and TUR, for HL. Taking into account procedure-related complications, the surgeon can choose the method with which he/she is most familiar and comfortable.
Patient summary
In patients with bladder pain syndrome with Hunner lesions, both endoscopic resection and coagulation of the lesions are effective treatments.
Keywords
Electrocoagulation; Interstitial cystitis; Recurrence; Therapeutics
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