Characteristics and electrocauterization of Hunner's lesions associated with bladder pain syndrome

Objective: This study was conducted to investigate patients with bladder pain syndrome (BPS) and cystoscopic findings of Hunner's lesion. The treatment and pathological findings related to Hunner's ulcers are unclear. The purpose of this study is to clarify the characteristics and to develop a new method for the diagnosis and treatment of Hunner's lesions in patient with BPS. Methods: From 2005 to 2011, 12 women with BPS were found to have bladder ulcers by cystoscopy without anesthesia. Previous therapy results for these patients had been limited. All patients received a bladder ulcer biopsy and cystoscopic electrocauterization in our hospital as treatment for the bladder ulcers. Patient demographics, patient clinical history, the characteristics of the cystoscopic findings, and treatment outcomes were recorded. Results: The cystoscopy characteristics of the bladder ulcers were central hyperemic patches with peripheral scarring and increased vascularity. Several subtypes of cystoscopic finding were also identified. The pathology findings of these patients included chronic cystitis with ulceration or eosinophilic cystitis. Mast cells and macrophages were also found in the bladder mucosa by immunohistochemical staining for c-kit and CD68. Nine of the 12 patients were immediately pain-free after electrocauterization, and the other three also showed a marked improvement. The patients' mean Visual Analogue Score before the operation was 9.64 +/- 0.81, and their mean Visual Analogue Score after electrocauterization showed significant improvement (2.95 +/- 1.85, p < 0.001). Bladder pain relapse occurred at 2-4 months after the procedure in six patients. Conclusion: Patients with BPS who show a poor response to conventional intravesical treatments should receive cystoscopy to identify ulcer type BPS. Treatment of patients by transurethral electrocauterization when they have ulcer type BPS is able to provide pain relief. Copyright (C) 2013, Taiwan Urological Association. Published by Elsevier Taiwan LLC. Open access under CC BY-NC-ND license.