Pelvic pain and dyscomfort

Frequent urination

Urge symptoms

Negative urine test

Exclusion of UTI

Presence of symptoms >3 months

Characteristic view at cystoscopy (in

70%)

Exclusion of all other bladder illnesses

Pelvic pain and dyscomfort

Frequent urination

Urge symptoms

Negative urine test

Exclusion of UTI

Presence of symptoms >3 months

Characteristic view at cystoscopy (in

70%)

Exclusion of all other bladder illnesses

Extension of visible mucosa glomerulations depends on:• level of intravesical pressure • time of dilation.

Standardization and optimization of these parameters is urgently needed.

Extension of visible mucosa glomerulations depends on:• level of intravesical pressure • time of dilation.

Standardization and optimization of these parameters is urgently needed.

Issues at conventional hydrodilation

Unreliable volume control

• Vesico-ureteral (renal) reflux

• Leakage through the urethra

Uncertainties at pressure adjustment

• Inaccurately defined zero level

• Reference pressure must correspond with perivesical pressure

• Adjustment of hydrostatic pressure is unexact

NEW METHOD NEEDEDNEW METHOD NEEDED

• Hyaluronate + 2% Lidocain solution into the

bladder• Balloon filled up to 70cmH2O• Keep pressure for 5 minutes• Quick collapse: ex vacuo bleedings

• Hyaluronate + 2% Lidocain solution into the

bladder• Balloon filled up to 70cmH2O• Keep pressure for 5 minutes• Quick collapse: ex vacuo bleedings

Standardized circumstances

After balloon dilation

Unequivocal lesions visible

Extended, deep coagulation (vaporization) of all mucosal glomerulations and ulcers

Bladder catheter for 16-24 hours

Adjuvant Hyaluronate + Lidocain instillations

Repeated instillations weekly 2x for 2 weeks, weekly 1x for 4 weeks (8 times)

Continuous follow up by questionaires and miction diary

Evaluation of pressure-volume relation:Always a bi-parabolic correlation!

Bladder wall rupture !Bladder wall rupture !

Suddenly decreasing pressure

Suddenly decreasing pressure

Evaluation of pressure-volume relation:cysto-elastometric PC software

Use balloon dilation of the bladder instead of conventional hydrodilation

Proved advantages:

- no leakage - no v-u reflux - exact and reliable pressure controll - better visualisation of all mucosal lesion - simultaneous high pressure drug delivery

Standardized parameters (pressure, time)

Summary of our experiences

Extended and deep coagulation of all mucosal lesions

Adjuvant GAG replenishment therapy helps (best timing, dose and durance ?)

Repeated procedure - if necessary - brings similar result

Evaluation of volume-pressure dependence let define new objective parameters: bladder volume, distensibility, grade of dilation

Presented method is of

Diagnostic valueBetter visualisation of all mucosal lesions

Therapeutic valueExtended coagulation of otherwise unvisible

lesions

Prognostic valueEvaluation of pressure-volume relation let rate

phase of the illness