[Hydrodistension in the therapeutic management of painful bladder syndrome].

INTRODUCTION

Hydrodistension is an integral part of the diagnostic assessment of painful bladder syndrome but also has a therapeutic effect. The purpose of this article is to review the literature on the place of brief and prolonged bladder hydrodistension in the therapeutic management of painful bladder syndrome.

MATERIAL AND

METHODS

A comprehensive review of the literature was performed by searching PubMed for articles on bladder hydrodistension in the management of painful bladder syndrome.

RESULTS

Brief hydrodistension is performed in the operating room under anaesthesia whenever the diagnosis of painful bladder syndrome is considered. The volume of distension varies according to bladder capacity and is obtained with a bladder pressure of 80 to 100 cmH(2)O. This brief distension must be maintained for 2 to 10 minutes. Prolonged hydrodistension is performed in the operating room under anaesthesia and consists of prolonged distension (20 to 30 minutes) during cystoscopy by insertion of a bladder catheter with distension balloon allowing distension over several hours with control of the bladder pressure. Complications of hydrodistension are rupture of the distension balloon requiring cystoscopy to remove the fragments and, very rarely, bladder rupture. The efficacy of hydrodistension is difficult to evaluate due to the heterogeneous studies, but appears to improve 50 to 70 % of patients. However, the effect tends to wane with time.

CONCLUSION

Hydrodistension is the first procedure performed for the diagnosis and treatment of painful bladder syndrome. Various modalities of distension have been described with no standardization of the procedure, but with significant although transient results on pain.