Fulguration of Bladder Lesions

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

Benefits:

The principle benefit of Hunner's ulcer fulguration is relief of bladder-based pelvic pain. Urinary frequency and urgency may also decrease.

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.
  2. Bleeding. Fulguration 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 can 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, but may take longer. A catheter may be needed in these instances.
  5. Bowel injury. The intestines lie behind the bladder. Very rarely, burning of the bladder wall may cause injury to the adjacent intestines and is more likely to occur with the use of laser therapy. Patients should notify their doctor immediately should mounting abdominal pain and/or fevers occur.

Alternatives to Fulguration of Hunner's ulcers

  1. Conservative therapies such as dietary changes, acupuncture, physical therapy
  2. Medical therapies such as Elmiron®, tricyclic antidepressants, antiseizure agents, narcotics, etc.
  3. Medications directly instilled into the bladder such as dimethylsulfoxide (DMSO), anesthetics, steroids, clorpactin (similar to Clorox®), etc.
  4. Surgery such as bladder removal (cystectomy)