Prognosis of conservative therapy of advanced interstitial cystitis: Experience of five cases

Background: It is generally believed that surgical procedures, particularly the more invasive ones, should be reserved for patients who fail to respond to conservative therapy by several established modalities. We studied whether conservative therapy was applicable to patients with interstitial cystitis (IC) in which an individual's awake bladder capacity decreases to 100 mL or less with vesicoureteral reflux (VUR). Methods: Five cases that satisfied the criteria proposed by the National Institutes of Health were examined. The maximum awake bladder capacity was 50–100 mL (average, 74 mL). The bladder capacity under anesthesia was 70–300 mL (average, 199 mL). Only conservative treatments were carried out. Results: The observation period ranged from 3 to 16 years with an average of 9 years. The awake bladder capacity ranged from 200 to 300 mL (average, 250 mL). The symptom index total score, which was previously 18.5, decreased to 5.5 and the problem index total score, which was previously 14.3, decreased to 3.5. Symptoms of bladder irritation improved. In four cases, VUR disappeared as the bladder capacity increased. Vesicoureteral reflux persisted in one case although its severity decreased and there was no fever. Conclusion: The patients treated with conservative therapy were able to maintain an awake bladder capacity that was sufficient for acceptable quality of life and their symptoms of bladder irritation improved. This suggests that we should regenerate the original remaining bladder using conservative therapy, even if IC is in a late stage.