The incidence of ulcerative forms of painful bladder syndrome/interstitial cystitis (PBS/IC) is 5-10 %. Among all forms of PBS/IC the clinical course of ulcerative form is the most severe, and the efficacy of its treatment is the least. Currently there is no single-treatment option that is effective in majority of patients with ulcerative lesions (Hunner’s lesions), thereby suggesting different conservative measures, as well as endoscopic methods of ablation (fulguration or resection) of these lesions. The aim of the study was to assess the results of laser ablation Hunner’s lesions in PBS/IC patients.

The study included 121 women aged 25 to 79 years (an average age was 52.8±15.1 years) with a diagnosis of PBS/IC established in accordance with the NIH/NIDDK criteria. All patients underwent cystoscopy with bladder hydrodystension under intravenous anesthesia according to the accepted protocol in our clinic. In 14 patients (11.6%), Hunner's lesions of the bladder were detected. The patients were divided into two groups. Group 1 patients (n=9) underwent laser ablation of Hunner's lesions, group 2 patients (n=5) underwent 3 months-long conservative therapy. The follow-up of these patients was performed 6 and 12 months after treatment or when symptoms recurred. The efficacy of treatment was evaluated using the PUF Scale questionnaire, Pain Visual Analog Scale (VAS), and voiding diaries. Treatment was considered effective if any of the following criteria were met: the decrease of the total scores on the PUF questionnaire scale by 20% or more, the decrease of the pain VAS score by 2 points or more, or a decrease in the frequency of urination by 20% or more in comparison with initial values.

Before treatment, the severity of clinical symptoms of PBS/IC in patients with ulcerative forms was significantly higher than in patients without Hunner's lesions: the severity of pain according to VAS was 8.2±1.1 and 7.3±1.5 points, the frequency of urination per day was 37.1±15.1 and 25.7±12.9 times, the average score on the PUF scale was 29.9±2.5 and 25.3±4.8 points, respectively. Six months after treatment, improvement was noted in 8 (88.9%) patients of group 1 and 2 (40%) patients of group 2. The clinical symptoms of PBS/IC in group 1 patients were less severe than in group 2 patients: the severity of pain according to VAS was 2.7 ±0.7 and 5.7±0.8 points, the total scores on the PUF questionnaire scale was 16.2±2.4 and 21.4±2.9 points, the frequency of urination per day was 13.7±2.5 and 19.2±3.1 times, respectively. Twelve months after treatment improvement in group 1 was maintained in 5 (55.6%) patients and in group 2 all patients showed a recur of symptoms to the initial level.

The severity of clinical symptoms in patients with ulcerative forms of PBS/IC is higher than in patients with non-ulcerative forms. The effectiveness of the standard conservative treatment of ulcerative forms of PBS/IC is low. Performing laser ablation of Hunner’s lesions significantly increases the effectiveness of treatment.

Endoscopic laser ablation of Hunner's lesions in patients with PBS/IC leads to a persistent improvement in the majority of patients and significantly exceeds the efficacy of standard conservative therapy.