Painful bladder syndrome/interstitial cystitis (PBS/IC) is a polyetiological disease with no definitive cause. In the pathogenesis of PBS/IC the main role is caused by urothelium dysfunctions, damage of the glycosaminoglycan layer of the bladder mucosa, urinary tract infections, hypoxia of the bladder wall and autoimmune factors. Numerous methods of BPS/IC treatment have been proposed, but the effectiveness of most of them is insufficient. In most cases patients with PBS/IC with Hunner's lesions have much more severe clinical manifestations of the disease and less treatment efficacy compared to patients without Hunner's lesions. In patients with Hunner's lesions transurethral resection, fulguration or laser ablation are recommended. However, with a large number of Hunner's lesions, surgical treatment is accompanied by a high risk of complications such as perforation of the bladder and then the beginning of fibrosis of the bladder wall with a decrease of its capacity. In this regard the development of new methods of treatment for this category of patients is very important.
The aim of the study was to evaluate the effectiveness of intravesical submucosal triamcinolone injections combined with bladder hydrodistension in PBS/IC patients with and without Hunner's lesions.

This study included 38 women (mean age 54.5 ± 8.7 years) with BPS/IC in accordance with the ESSIC criteria. All patients previously got conservative therapy for this disease without any sufficient effect. All patients underwent cystoscopy and hydrodistension with intravenous anesthesia, during this procedure the pressure in the bladder was 60 cm of H2O for 2 minutes. Then all patients underwent submucosal injections of a solution of triamcinolone (40 mg / ml) at 20 points 0.5 ml each. In the presence of Hunner's lesions injections were made directly into them. Treatment efficacy was assessed using the Pelvic pain and urgency / frequency patient symptom score (PUF), the 10-point visual analogue pain scale (VAS), and the QoL questionnaire. Control examination was performed 1 month after treatment.

The results of cystoscopy with hydrodistension of the bladder showed the presence of PBS/IC without Hunner's lesions in 25 patients (group 1) and the presence of Hunner's lesions in 13 patients (group 2). Clinical symptoms were more severe in patients of the 2nd group. One month after treatment 34 (89.5%) women noted a significant improvement in their condition with a positive effect in both groups of patients (table).
Intravesical infections with triamcinolone in combination with hydrodistension of the bladder were well tolerated by patients, there were no complications during surgery or in the postoperative period.

The mechanism of the therapeutic action of triamcinolone and bladder hydrodistension in patients with BPS/IC is different. Triamcinolone is a synthetic glucocorticosteroid with anti-inflammatory, anti-allergic and anti-edema effect. Bladder hydrodistension contributes decreasing in bladder sensitivity due to ischemic necrosis of sensory nerves in the bladder wall. One of the main factors in the pathogenesis of PBS/IC are considered with the activation of mast cells and the enhanced release of biologically active substances that affect afferent receptors in the bladder wall. In our opinion the high clinical efficacy of the combination of urinary bladder hydrodistension and triamcinolone happens because of the synergistic effect.

Submucosal triamcinolone injections in combination with bladder hydrodistension have shown high clinical efficacy in patients with PBS/IC. There were no significant differences in their effectiveness depending on the presence of Hunner's lesions.