TREATMENT OF INTERSTITIAL CYSTITIS - COMPARISON OF SUBTRIGONAL AND SUPRATRIGONAL CYSTECTOMY COMBINED WITH ORTHOTOPIC BLADDER SUBSTITUTION

Purpose: We retrospectively evaluate the outcome of interstitial cysti tis treated with subtrigonal or supratrigonal cystectomy and orthotopi c bladder substitution. Materials and Methods: Of 22 women and 1 man a mean of 51 years old with interstitial cystitis refractory to conserv ative therapy 17 were treated with subtrigonal cystectomy and ureteral reimplantation (group 1), and 6 were treated with supratrigonal cyste ctomy directly above the ureteral orifices (group 2). Both groups unde rwent orthotopic bladder substitution with an ileocecal pouch (Mainz p ouch I). Results: Postoperatively functional capacity significantly in creased from a mean plus or minus standard error of mean 46 +/- 5 to 3 46 +/- 57 ml. in group 1 and 34 +/- 61 to 319 +/- 29 ml. in group 2 (p <0.001). Daytime and nighttime urinary frequency significantly decrea sed from 24 +/- 2 to 8 +/- 1 and 7 +/- 1 to 2 +/- 1 ml., respectively, in group 1 and 28 +/- 2 to 6 +/- 1 and 6 +/- 1 to 1 +/- 1 ml., respec tively, in group 2 (p <0.001). At a mean followup of 93.9 months 14 pa tients in group 1 (82%) are completely symptom-free, and 1 has tolerab le residual urinary urgency and suprapubic pain. At a mean followup of 31.5 months all group 2 patients are symptom-free and void spontaneou sly, whereas 41% of the group 1 patients require self-catheterization after subtrigonal cystectomy. Conclusions: For interstitial cystitis r efractory to conservative treatment subtotal cystectomy with orthotopi c bladder substitution with the ileocecal pouch (Mainz pouch I) is a v alid therapeutic option. In this series supratrigonal and subtrigonal cystectomy resulted in similar relief of symptoms but the former appea rs to provide better functional bladder rehabilitation.