Editorial Comment on Long‐Term Clinical Outcome of Transurethral Resection of Hunner Lesions Combined With Bladder Hydrodistention for Patients With Interstitial Cystitis at a Tertiary Center in Japan

In this article, Professor Yoshiyuki Akiyama et al. reported a large series of the long-term outcomes of bladder hydrodistention plus transurethral resection (TUR) of Hunner's lesion (HL) for patients with Hunner's interstitial cystitis (HIC). The success rates within the first postoperative year are satisfactory. Although more than 50% of patients need repeat procedure, the result of this study has highlighted that the first-line treatment for HIC is ablation of HL using TUR, electrofulguration, or laser ablation [1]. Whether hydrodistention before TUR of HL can provide additional benefit to increase bladder capacity and relieve pain deserves further investigation. To determine whether the IC is bladder-centric or non-bladder-centric and whether it represents HIC or non-HIC is important, as the initial management strategies differ markedly between these subtypes [1]. Therefore, office-based cystoscopic examination without anesthesia is mandatory in patients presenting with intractable bladder pain and reduced bladder capacity to identify the presence of HL [2, 3]. Once HL has been resected, most patients experience prompt bladder pain relief following the procedure. Although HL may recur, repeated ablation remains effective, and bladder capacity typically remains stable or increased after successive procedures. The cause why HIC will relapse is mostly because the surgeon does not resect all the inflammatory tissues in the bladder wall. In this regard, bladder computed tomography is recommended to assess the bladder wall if HL recurs frequently [4]. In cases where the bladder wall is diffusely thickened, wide resection of the lesions, or injection triamcinolone into the bladder wall surrounding the ablated HL will be helpful. Recently, we have administered intravesical injection of platelet-rich plasma combined with triamcinolone at HL sites after transurethral fulguration, and patients reported rapid pain relief and favorable re-epithelialization of lesion sites [5]. The most suitable and effective treatments for HIC have evolved with time and are promising. Hann-Chorng Kuo: conceptualization, writing – review and editing. The author declares no conflicts of interest. This article is linked to Akiyama et al. paper. To view this article, visit https://doi.org/10.1111/iju.70227.