What is the role of diversion in the absence of cystectomy in the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS)?

Updated: Dec 04, 2020
  • Author: Eric S Rovner, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Some studies have investigated a role for diversion in the absence of cystectomy as a therapy. Norus et al showed that no differences in symptoms were reported in patients who underwent ileal conduit after cystectomy compared with those who underwent ileal conduit without cystectomy, suggesting this as an appropriate option in carefully selected patients. [107] In a study by Peters in 2013, 10 women with previous ulcerative IC/BPS underwent cystectomy and urinary diversion (1 with a neobladder, 9 with ilealconduit). Despite 6 of the patients requiring reoperation, 8 of 9 reported significant improvements in quality of life and would make the same decision again. IC/BPS pain had resolved in 8 of 9 respondents in follow-up surveys. [21]

Surgeons should be reminded, however, that significant improvements were seen in those with ulcerative IC/BPS, and results in those with nonulcerative disease had poorer outcomes. [108]

However, as these therapies are highly invasive and evidence in the literature is composed only of very small studies, they should be reserved for patients who have been extensively counseled and in whom prior therapies have failed. As severe, refractory IC/BPS is considered by some to be an "orphan disease," treatments should be tailored to the individual to offer the best chance for a successful outcome. [108]


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