Hydrodistention

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The basic benefits, risks, and alternatives to hydrodistention...

Benefits:

The principle benefit of hydrodistention is to better determine your diagnosis. The diagnosis of interstitial cystitis is made by combining your medical history, physical examination, and other testing together with this procedure. Apart from helping to diagnose IC, hydrodistention findings give clues to your prognosis. For example, a very small bladder capacity at the time of hydrodistention likely portends a worse prognosis compared to the patient with a higher capacity. Following hydrodistention, approximately 30% of patients have a transient improvement in their IC related symptoms.

Risks:

  1. Infection. Infection is very uncommon after hydrodistention. Antibiotics are typically administered intravenously during the procedure and/or are given to patients to take by mouth a few days after the procedure. Any patient who has a prosthetic device, a heart valve abnormality, or any reason for antibiotics to be given during a dental procedure should mention this to the surgeon and anesthesiologist.
  2. Bleeding. Hydrodistention in the face of interstitial cystitis usually causes bleeding from the bladder surface. Therefore, it's quite common to see blood tinged urine. Occasionally, small clots may be passed. This may last for several days and may even occur intermittently for the next few weeks. If bleeding progressively worsens, your physician needs to be called immediately.
  3. Bladder perforation. This is a rare event which usually occurs in bladder's that are very diseased. In these instances, healing of the bladder can be facilitated by leaving a catheter in the bladder (through the urethra) for 7-10 days. Very rarely, the bladder perforation is so significant as to require an "open" repair.
  4. Urinary retention. In some patients, stretching of the bladder or effects from your anesthetic agents cause the bladder to temporarily lose its ability to contract. Bladder function typically returns the next day.
  5. Bladder necrosis. Necrosis means that the bladder wall dies, likely due to a loss in its blood supply (similar to a "heart attack"). This is an extremely rare event, only three cases having been reported in the world's literature.

Alternatives to Hydrodistention

  1. "Anesthetic challenge." In order to determine the source of pelvic pain, an anesthetic agent may be placed into the bladder. If pain subsides, its origin is likely the bladder. Uncommon adverse effects are short-lived urinary retention and rarely a short-lived worsening of pain when the anesthetic wears off.
  2. Potassium sensitivity testing. By placing a solution of potassium chloride into the bladder, IC symptoms (urgency, frequency, pain) can be provoked in the office setting. I rarely perform this procedure because it may cause significant patient discomfort.
  3. Empiric Diagnosis. The diagnosis of interstitial cystitis can sometimes be made when all of the signs and symptoms of this condition are present and all other diseases have been excluded.