Non-Hunner's Interstitial Cystitis Is Different from Hunner's Interstitial Cystitis and May Be Curable by Uterosacral...

Area of Science:

• Urogynecology
• Pelvic Floor Disorders
• Urologic Health

Background:

• Posterior fornix syndrome (PFS) is a condition characterized by chronic pelvic pain (CPP), urinary urgency, frequency, nocturia, and emptying difficulties, linked to uterosacral ligament (USL) laxity.
• PFS symptoms are predictably relieved by surgical repair of the USL.

Purpose of the Study:

• To investigate the hypothesis that non-Hunner's interstitial cystitis (IC) and PFS are equivalent conditions.
• To determine a causal relationship between IC and pelvic organ prolapse (POP).
• To assess the prevalence and types of pelvic symptoms in patients with POP-related IC.

Main Methods:

• Retrospective study of 198 women with CPP, uterine/apical prolapse, and PFS symptoms treated with posterior USL sling repair.
• Comparison of patient symptoms with definitions of IC, CPP, and bladder symptoms.
• Utilized validated questionnaires, simulated operations, transperineal ultrasound, and urodynamics to test the hypothesis.

Main Results:

• 198 patients experienced CPP, and 313 had urinary symptoms consistent with non-Hunner's IC.
• High cure rates were observed after USL sling repair: CPP (74%), urge incontinence (80%), frequency (79.6%), abnormal emptying (53%), nocturia (79%), and obstructive defecation (80%).

Conclusions:

• Findings support the hypothesis that non-Hunner's IC and PFS are similar conditions.
• Non-Hunner's IC/BPS may represent a distinct or lesser condition compared to Hunner lesion disease.
• Further rigorous investigation, ideally randomized controlled trials, is warranted.