Bladder Hydrodistention and Fulguration of Hunner’s Lesions in Patients With Bladder Pain Syndrome

INTRODUCTION: Bladder pain syndrome is defined as an unpleasant sensation, such as pain, pressure, or discomfort, lasting more than 6 weeks’ duration and perceived by the patient to be related to the bladder, without evidence of infection or other identifiable causes. This condition is likely underdiagnosed, and the chronic pain associated with it can have a profound impact on quality of life. Patients may present with the classic symptoms of pain with bladder filling that is relieved with bladder emptying or may present with more vague symptoms such as urinary urgency and frequency (with or without leakage), urethral pain, generalized pelvic pain, or reports of recurrent UTI symptoms with sterile cultures. Although cystoscopy is not required to make the diagnosis of bladder pain syndrome, 10–15% of patients with bladder pain syndrome will have characteristic Hunner’s lesions identified on cystoscopy. These patients are often refractory to traditional first-line treatments for bladder pain syndrome; however, they have good response to bladder hydrodistention and fulguration of Hunner's lesions. OBJECTIVE: The objective of this video is to discuss bladder pain syndrome, emphasize its impact on patients' quality of life, and demonstrate the procedural techniques of bladder hydrodistention and fulguration of Hunner's lesions in treatment of this condition. METHODS: Surgical video was obtained from two different bladder hydrodistention and Hunner's lesion fulguration procedures performed on the same patient at different times. RESULTS: There are no results to report. CONCLUSIONS: Bladder pain syndrome is a chronic condition that significantly impacts patients’ quality of life; however, appropriate diagnosis and treatment can profoundly improve symptoms. This condition is often underdiagnosed and should remain on the differential when working up a patient with chronic pelvic pain. Cystoscopy with hydrodistention and fulguration of Hunner’s lesions are important treatments for the management of these patients who are often refractory to other treatment modalities.Figure 1