Rr. Lotenfoe et al., ABSENCE OF NEUROPATHIC PELVIC PAIN AND FAVORABLE PSYCHOLOGICAL PROFILE IN THE SURGICAL SELECTION OF PATIENTS WITH DISABLING INTERSTITIAL CYSTITIS, The Journal of urology, 154(6), 1995, pp. 2039-2042
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.