SUBSTITUTION CYSTOPLASTY FOR INTRACTABLE INTERSTITIAL CYSTITIS

Objective To assess the results of substitution cystoplasty for the tr eatment of intractable interstitial cystitis (IC). Patients and method s Thirty-two patients (29 women and three men; mean age 58 years, rang e 24-74) with intractable IC resistant to conservative therapy who had undergone substitution cystoplasty between 1983 and 1992 were reviewe d. Their bladder capacities were measured pre-operatively and related to the outcome of treatment. Results All but two of the 22 women with a bladder capacity of <250 ml,under anaesthetic were improved (five) o r cured (15) of their symptoms, The results in women with larger bladd er capacities were much less reliable, with only two of seven being cu red of their symptoms, The three men all had a good result, Those who had undergone supratrigonal cystectomy were more likely to void sponta neously, but four patients developed pyelonephritis from associated re flux. Subtotal cystectomy reduced the likelihood of reflux and, althou gh there were too few patients for statistical significance, probably increased the chance of cure at the expense of increasing the need for intermittent self-catheterization (ISC). Conclusions Pre-operative bl adder capacity under anaesthetic is the most reliable predictor of out come of substitution cystoplasty for treating intractable IC in women. It is contra-indicated if bladder capacity is >250 mt. Supratrigonal cystectomy is a quick and easy operation and is preferable in the olde r patient, Subtotal cystectomy with reimplantation of the ureters is p referable in the younger patient, even though it may increase the need for ISC.