Fulguration of Bladder Lesions

Overview

"Fulguration" of a bladder lesion means to destroy the lesion by burning it. Fulguration may be performed in a variety of ways, most commonly with the use of electrocautery or laser. The procedure is usually performed for treatment of bladder cancers or in the case of interstitial cystitis, for inflamed areas, called Hunner's ulcers.

Fulguration of Hunner's ulcers is usually performed to decrease pain. Hunner's ulcers likely cause pain due to the inflammation affecting surrounding nerves. Stretching of these areas as the bladder fills often dramatically increases pain. Pain also often occurs as the bladder empties, likely due to the Hunner's ulcer coming in contact with other bladder surfaces.

The concept of Hunner's ulcer fulguration is to destroy local nerves and to cause a decrease in substances that cause inflammation. The most common reason to proceed with fulguration of a Hunner's ulcer is pain. Fulguration is generally recommended when more conservative therapies have failed.

Fulguration of Hunner's ulcers results in greater than 50% improvement in pain in over 90% of patients. When urinary frequency decreases, it's usually the result of less pain during bladder filling. The downside of Hunner's ulcer fulguration is that it is not a cure. Most patients develop new ulcers and pain within 3-9 months. In some cases, fulguration may cause more bladder wall scarring (from the burning of its surface) and ultimately decrease the bladder's capacity.

On the other hand, there are patients who have significant symptom relief for years. Additionally, with pain effectively managed, various bladder retraining techniques can be employed to ultimately increase the bladder's capacity.

Fulguration is usually performed under general or spinal anesthesia since most patients cannot tolerate the discomfort of bladder filling. Filling of the bladder is performed through a cystoscope. The cystoscope is inserted into the urethra, the tube that allows urine to pass out of your body.

Before fulguration of the bladder wall, a biopsy may be taken of the area in question. The biopsy is performed directly through the cystoscope. The amount of tissue taken is about the size of this "O." On occasion, several biopsies are obtained. The biopsies are usually assessed for the presence of inflammation and/or cancer.

In most instances, an anesthetic solution is left in the bladder at the end of the procedure to decrease the patient's discomfort when the anesthesia wears off.