Anti-inflammatory bladder hydrodistension combined with pudendal nerve block in interstitial cystitis

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition with unclear pathophysiology and limited standardized treatments. This retrospective analysis evaluates the association of a combined approach including prolonged hydrodistension, intravesical instillation, and bilateral pudendal nerve block with symptom improvement.

Data from 64 patients, from December 2016 to June 2023, were analyzed, including demographic information, symptoms, intraoperative details, Interstitial Cystitis Symptoms Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Visual Analogue Scale (VAS) for pain, and daily frequencies at baseline, 1 and 6 months. Patients underwent prolonged hydrodistension with intravesical prednisolone followed by instillation of NaHCO₃, bupivacaine, prednisolone, and heparin sulphate. A bilateral pudendal nerve block was then performed under fluoroscopic guidance.

Mean basal bladder capacity under general anaesthesia increased from 389.45mL to 537.34 ml and 629.91 ml after the first and second hydrodistension, respectively. Intravesical instillations and bilateral nerve block were performed in 90.6% and 95.3% of cases, respectively. ICSI decreased from 21.05 ±2.27 at baseline to 8.89 ±3.88 at 1 month and 13.87 ±5.42 at 6 months (p <0.0001). ICPI showed similar improvement. VAS pain scores significantly decreased at follow-up. Symptom improvement correlated with increased bladder capacity and higher baseline ICPI, while pain reduction was predicted by higher ICPI and diurnal frequency, lower baseline bladder capacity, and increased capacity after the second hydrodistension.

The combined approach of prolonged bladder anti-inflammatory hydrodistension and bilateral pudendal nerve block shows a short-term association with improvement in the management of IC/BPS. The observed early improvements in symptoms warrant further prospective studies with larger cohorts to confirm durability and to evaluate the role of repeat procedures.