Urinary diversion in the treatment of refractory bladder pain syndrome

Objectives: This study investigates the effect of urinary division in patients with bladder pain syndrome (BPS) refractory to conservative treatment. This study aimed to identify pre-operative predictive factors regarding the surgical outcome in patients undergoing urinary diversion with or without cystectomy (CX).Methods and patients: This study included 30 patients with BPS treated with a urinary diversion in the period from 2002-2017 at a single university hospital. The surgical procedure was selected on an individual basis, including both continent and non-continent diversions and primary procedure with or without concomitant CX. Pre- and post-operative data were registered retrospectively through medical chart review.Results: Eight patients were treated with primary CX and eight had secondary CX within a short time following urinary diversion (1.45 years in median), mainly due to persisting pain. However, more than half the patients were successfully treated with urinary diversion alone throughout the follow-up period (estimated 58% after 12 years). Nine patients were prior to surgery diagnosed with Hunner's lesions, and these had significantly greater pain relief compared to the remaining 21 patients (p = 0.02). The higher success rate of the bladder-preserving procedure was suggested in patients older than 48 years (p = 0.09) with less pain pre-operatively, estimated by less than three opioids prior to the procedure (p = 0.01).Conclusions: Surgical treatment with urinary diversion should be taken into consideration for refractory BPS, especially patients diagnosed with Hunner's lesions. These results support a bladder-preserving strategy unless the patient is young or has severe treatment refractory pain pre-operative.