Gender Disparities in Procedural Management of Hunner Lesion Interstitial Cystitis

Interstitial cystitis/bladder pain syndrome (IC/BPS) is marked by chronic pelvic pain and urinary symptoms, affecting millions. Hunner-type IC (HIC), representing ~20% of cases, is characterized by distinct inflammatory pathology and worse symptom severity. Despite evidence of sex-based differences in IC/BPS, data specific to HIC remains sparse. This study examined sex differences in clinical presentation, management, and outcomes in HIC patients.

Single-center retrospective analysis of 114 patients with confirmed HIC managed between 2011 and 2024. We assessed sex-based differences across clinical presentation, diagnostic timelines, treatments, and quality of life. Cox proportional hazards models identified predictors of repeat fulguration and cystectomy.

Among 114 patients (68% female with median age of 68 years) females reported more anxiety (33.3% vs. 13.9%, OR 3.13, p = 0.04), recurrent/multidrug-resistant UTIs (p < 0.001, OR 8.37,p = 0.02), and pelvic pain (55.1% vs. 30.6%, OR 2.50, p = 0.02), longer wait times to biopsy 2.94 versus 0.77 months, p = 0.026), and underwent more bladder instillations (32.9% vs. 11.8%, OR 3.57 p = 0.02). Males more frequently reported nocturia (33.3% vs. 12.8%, OR 3.4, p = 0.02). In multivariate analysis, male sex (HR 3.69, p = 0.006), greater Hunner lesion burden on first cystoscopy (HR 1.35, p = 0.035), and absence of pelvic pain (HR 0.33, p = 0.031) independently predicted repeat fulguration; protection was associated with anticholinergic/beta-agonist use (HR 0.14, p = 0.003). Cystectomy was predicted by MDR-UTI (p < 0.001), narcotic use (p = 0.009), neuromodulation history (p = 0.016), recurrent UTIs (p = 0.031), and hematuria (p = 0.004), independent of sex.

Sex-based differences in HIC presentation and management exist despite comparable disease severity, with females showing higher symptom burden and male sex predicting repeat fulguration. Cystectomy progression was driven by clinical severity markers rather than sex. These findings support the need for sex-stratified diagnostic and treatment algorithms and prospective validation studies.