A Survey on Real-World Transurethral Surgery Procedures for Bladder Pain Syndrome and Interstitial Cystitis

To investigate real-world practices in transurethral surgeries for bladder pain syndrome (BPS) and interstitial cystitis (IC) in Japan, with a focus on procedural characteristics of hydrodistension (HD) and transurethral elimination of Hunner lesions (TUEH).

An internet-based questionnaire was sent to all members of the Society of Interstitial Cystitis of Japan in November 2024. The survey inquired about institutional characteristics, the number of procedures performed in the previous 12 months, and detailed surgical techniques. BPS was defined by the absence of Hunner lesions, and IC by their presence. Responses were analyzed to describe procedural patterns and compare practices between HD and TUEH.

Of 205 eligible members, 86 responded (response rate: 42%). Among them, 52 had performed HD for BPS and 67 had performed TUEH for IC within the study period. Most surgeons distended the bladder to a preset pressure of ≤ 80 cm H₂O for 3-10 min and repeated the procedure at least twice during HD. At TUEH, coagulation was preferred over resection to eliminate Hunner lesions. HD was frequently co-performed, though the sequence of elimination and HD varied. Compared to HD, TUEH more often relied on abdominal palpation rather than fixed pressure, used shorter distension time, and involved longer catheter placement.

This nationwide survey highlights contemporary surgical practices for BPS and IC in Japan. These findings may help clinicians evaluate and refine their own approaches to transurethral interventions for these complex conditions.