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Surgical intervention for BPS/IC is complex and should only be performed as a last resort by specialist surgeons, if all available treatments have failed and a patient’s pain is disabling.1,51,54,55

Fulguration or resection of lesions

Fulguration of Hunner’s lesions involves using electricity or a laser to burn them. When the area heals, the dead tissue and lesions fall off leaving new, healthy tissue behind.1,52,54,55

Resection of lesions - involves cutting around and removing the lesions.1,52,54,55

Both treatments are done under anaesthesia and use special instruments inserted into the bladder through a fulguration cystoscope.1,52,54,55

Bladder augmentation/substitution

This ‘rarely used’ surgical option is only suitable for the most severely debilitating cases of BPS/IC. Inflamed sections are removed – so only the base and healthy tissue is left. Then a piece of the colon is also removed, reshaped and attached to what remains of the bladder. An augmented bladder has greater capacity, and coordinated bladder contractions (spasms) are also prevented. Most patients will have to use a catheter to empty an augmented bladder. The effect on pain varies greatly, and BPS/IC can sometimes recur on the segment of colon used to enlarge the bladder.1,51,52,55

Bladder removal or cystectomy

Various methods are used to reroute urine, when a bladder is removed.1,52,54,55

A neobladder can be formed from bowel that’s refashioned into a pouch, then attached to the urethra. So, the patient can empty their bladder by abdominal pressure or in most cases with a catheter. Patients, who aren’t able to catheterise because of a painful urethra, can have a tube fashioned from their appendix or bowel to empty their bladder through the umbilicus or abdominal wall.1,52,54,55

A urostomy is a simpler diversion of urine, the ureters are attached to a piece of colon that opens onto the skin of the abdomen – the opening is called a stoma. Urine empties through the stoma into a bag attached to the abdominal wall.1,52,54,55

Kidney infection, small bowel obstruction and metabolic (salt) disturbance are potential serious complications that can occur because of these procedures.1,52,54,55


  • 1.Meijlink JM. Interstitial Cystitis/Bladder Pain Syndrome. Int Painful Bl Found. 2014.
  • 51.Tirlapur S, Birch J, Carberry C, et al. Management of Bladder Pain Syndrome: RCOG Green-Top Guideline No. 70. Vol 124.; 2016. doi:10.1111/1471-0528.14310.
  • 52.London Urology. Painful bladder syndrome (PBS) and Interstitial Cystitis (IC) Painful. www.londonurology.org.uk/services/bladder-pelvic-pain/. Published 2017. Accessed September 1, 2017.
  • 54.Hanno PM, Burks DA, Clemens JQ, et al. AUA Guideline for the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome. J Urol. 2011;185:2162-2170. doi:10.1016/j.juro.2011.03.064.
  • 55.Hanno PM, Burks DA, Clemens JQ, et al. Diagnosis and Treatment Interstitial Cystitis / Bladder Pain Syndrome.; 2014.