Role of patch cystoplasty in intractable interstitial cystitis/bladder pain syndrome.

Purpose: Management of intractable interstitial cystitis/bladder pain syndrome (IC/BPS) is very challenging with no standard treatment. Reconstructive surgery is one of the options. Here, we present our long-term experience of treating intractable IC/BPS with patch/clam ileocystoplasty. Patients and Methods: From September 2012, 19 patients diagnosed with IC/BPS underwent patch cystoplasty. Two patients died, so data from 17 patients was analyzed. 15-20 cm segment of the ileum was isolated, leaving distal most 15 cm of ileum from the ileocecal junction intact. The urinary bladder was opened judiciously in the sagittal section, incising anteriorly from the bladder neck to trigone posteriorly. The patch of the ileum was opened at the antimesenteric border and interposed between the two halves of the bladder. Two suprapubic catheters were placed through the bladder segment. No urethral catheter was placed. A global response assessment questionnaire, 10-point pain scale, interstitial cystitis symptom index, and interstitial cystitis problem index were used to evaluate the response to treatment. Results: The average age of the patients included was 47 years, 11 females and 6 males. The average follow-up was of 3.9 years, and the median was 3 years. All 17 patients improved, 13 showed marked improvement and 4 moderate improvement. 11 patients had Hunners Lesion, 14 patients are voiding naturally and 3 are on self-catheterization. Conclusions: For IC/BPS, surgery should be offered as the last treatment option in cases of intractable disease. In our series, Patch cystoplasty has shown favorable results with satisfactory outcomes and minimum morbidity, and better quality of life even on long-term follow-up.