Patterns and predictors of Hunner lesion recurrence in patients with interstitial cystitis.

ABSTRACT

AIMS: To evaluate the patterns and predictive factors associated with Hunner lesions (HLs) recurrence in patients with interstitial cystitis (IC). METHODS: This study was a retrospective analysis of data from patients with IC who underwent transurethral resection and cauterization (TUR-C) of HLs between October 2011 and December 2017. Symptoms were evaluated using the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF), O'Leary-Sant Interstitial Cystitis Symptom Index, and Visual Analogue Scale (VAS). Patients attended follow-up visits every 3 months; cystoscopy was performed immediately in patients with aggravated symptoms. Recurrence was defined as a VAS score greater than or equal to 4 and HLs recurrence on cystoscopy. RESULTS: A total of 91 patients were enrolled (25 male, 66 female) median follow-up was 30.6 months. HLs recurrence occurred in 101 sites (53 patients), 21.8% in the previous TUR-C site, 18.8% de novo, and 59.4% at both previous and de novo sites. The recurrence rate was approximately 12.7%, 40%, and 55.2% at 6, 12, and 18 months, respectively. A higher PUF bother score was the only predictive factor of recurrence (odds ratio 1.142, 95% confidence interval 1.016-1.284, P = 0.026), with a cut-off value of 7.5 (sensitivity 67.9%, specificity 62.5%). In case of late recurrence (>18 months), there was no predictive factor. CONCLUSIONS: The HLs recurrence pattern was unpredictable, involving both previous TUR-C and de novo areas. More accurately defining the HLs resection margin may lead to better surgical outcomes but this remains to be proven.