ABSENCE OF NEUROPATHIC PELVIC PAIN AND FAVORABLE PSYCHOLOGICAL PROFILE IN THE SURGICAL SELECTION OF PATIENTS WITH DISABLING INTERSTITIAL CYSTITIS

Purpose: We evaluated the results among patients with disabling inters titial cystitis treated by cystectomy, urethrectomy and creation of a continent colonic urinary reservoir (the Florida pouch). The value of psychological evaluation and pain localization techniques, as well as the use of a team approach in the evaluation of these patients were as sessed. Materials and Methods: The 20 women and 2 men who underwent su rgery for disabling interstitial cystitis ranged from 31 to 75 years o ld (mean age 48). The duration of symptoms ranged from 2 to 14 years ( mean 7). All patients had undergone multiple prior therapies, includin g vesical hydrodistension, instillations, laser treatments, and use of tranquilizers and a variety of pain medications. Patients underwent a clinical, cystoscopic (with bladder biopsies) and urodynamic evaluati on as well as examination by a gynecologist with expertise in vaginal ultrasonography. The last 5 patients underwent psychological evaluatio n and pain localization techniques. Results: Among the clinical parame ters, the presence of a small capacity bladder with the patient under anesthesia (less than 400 cc) was associated with the best surgical re sults. Among 11 patients evaluated only clinically success was achieve d in 64%, while all 5 (100%) who also underwent pain localization tech niques and psychological evaluation had a successful outcome postopera tively. The overall surgical success rate in the 22 patients was 73%. Two patients undergoing psychological evaluation and pain localization techniques were not considered to be surgical candidates. Among 7 sur gical failures 4 patients underwent postoperative psychological evalua tion and pain localization techniques, and they would not have been co nsidered candidates for surgery with the new parameters. Conclusions: A team approach is essential in the evaluation of these patients. Foll owing the initial selection of patients who had a small bladder capaci ty while under anesthesia, psychological evaluation and pain localizin g techniques may assist surgeons in selecting those who would benefit from a radical operation.