Management of bladder pain syndrome with Hunner's lesions: A series of 32 cases

The recommendations of the European association of urology (EAU) suggests treating the bladder phenotype with Hunner's lesion (HL) associated with bladder pain syndrome (BPS) by transurethral resection (TUR) or coagulation of the lesions. We present the results of this approach in our practice.

Retrospective monocentric study including consecutive patients presenting BPS with HL assessed during cystoscopy between 1998 and 2026. Patients were divided in two groups according to treatment strategy: group 1 with medical management (association of cimetidine or bladder instillations of RIMSO or pentosan polysulfate de sodium [CRP]) and group 2 with surgical management (immediate TUR, repeated if pain and HL recurrence). The primary objective was to compare success of each management strategy, defined by complete resolution of pain. Secondary objectives were to describe efficacy on pollakiuria symptoms and morbidity of surgical management.

Thirty-two patients were included (group 1 n=9, group 2 n=23). Success of treatment was achieved in 11.1% (1/9) cases in group 1 and in 78.2% (18/23) cases in group 2 (P=0.001). In group 1, the only pain resolution was observed after RIMSO bladder instillation. In group 2, 61.1% (11/18) experienced a pain recurrence after being cured with a median delay of 13 [6-30.25] months. Twelve patients required a 2nd TUR. Resolution of pollakiuria occurred in 0% in group 1 and 34.8% (8/23) in group 2 (P=0.07). Three patients required reintervention after TUR, 2 for bladder perforation (1 open and 1 laparoscopic bladder repair), 1 for gross haematuria requiring coagulation and 12.5% (4/32) patients ultimately underwent cystectomy.

In case of BPS with a bladder phenotype and one or more Hunner's lesions, treatment by transurethral resection of the inflammatory lesion is more effective for pain and, to a lesser extent, for pollakiuria than our usual medical treatment (CRP) but does not prevent recurrence after varying periods of time.