Female Urology Anesthetic Bladder Hydrodistention Is Superior to Superior Hypogastric Plexus Neurolysis in Treatment of Interstitial Cystitisebladder Pain Syndrome: A Prospective Randomized Trial Ahmed S. El-Hefnawy, Mohamed Y. Makharita, Ahmed Abed, Yasser M. Amr, Mohamed Salah El-badry, and Attallah A. Shaaban OBJECTIVE To evaluate efficacy and safety of superior hypogastric plexus neurolysis (SHN) for treatment of interstitial cystitis (IC)ebladder pain syndrome (BPS) in comparison with bladder hydro- distention (HD). MATERIALS AND METHODS In a prospective study, 24 female patients were randomly allocated to receive either SHN or HD. Patients were evaluated by recording the O’Leary-Sant IC symptom indices, IC problem indices, pain visual analog scale (VAS), number of daytime frequency, and nocturia. Pressure flow study was conducted for all patients. Intraoperative and postoperative changes and adverse events were recorded. RESULTS Basal IC symptom indices, IC problem indices, and VAS scores were comparable between both groups (P ¼ .31, .63, and .94, respectively). There was no statistically significant difference be- tween both groups with respect to urodynamic parameters. Only pain VAS at first week was improved in SHN in comparison with HD (P ¼ .012). Thereafter, all parameters were signifi- cantly improved in favor of the HD group at 2- and 4-week visits. Adverse events in both groups were ranked as Grade 1 Clavien-Dindo classification including transient hematuria in the HD group and transient back ache in the SHN group. CONCLUSION Despite effective pain control in cases with IC-BPS after SHN, it lacks durability. It seems that SHN in its current form is not to be a suitable line of treatment for IC-BPS. Multimodality treatment would be needed for proper control of patients’ symptoms. UROLOGY 85: 1039e1044, 2015. Ó 2015 Elsevier Inc. I nterstitial cystitis (IC)ebladder pain syndrome (BPS) is a disease in which patients experience chronic pelvic pain, frequency, and urgency. 1,2 The underlying pathophysiology of such condition is still un- known, and diagnosis is based mainly on exclusion of other lower urinary tract disorders. 3 Different treatment types of behavioral, dietary, interventional, and phar- macologic therapies have been used; however, there is no single or even combined satisfactory treatment protocol for IC-BPS until now. 4 Recently, an algorithm was sug- gested by the American Urologic Association starting with conservative management and, then, graduating to more invasive treatment modalities, culminating in uri- nary diversion and even cystectomy. 5 In daily clinical practice, the outcome of first conser- vative line is usually poor and not convinced. 6 Oral drug therapy was recommended as a second-line treatment for IC-BPS by the guidelines including amitriptyline, cimetidine, hydroxyzine, or pentosan polysulfate sodium. However, the modest response in expense of bothering adverse effect or high cost limits its use. 7 Currently, hydrodistention (HD) of urinary bladder is considered as third line of management of IC-BPS besides its role as a diagnostic tool. 8 Many studies have shown the effec- tiveness of HD in improvement of patients’ symptoms, but it has poor long-term efficacy. 9-11 Because pelvic pain is considered as the main both- ering symptom in IC-BPS, efforts should be focused for development of an effective and compliant pain-control Financial Disclosure: The authors declare that they have no relevant financial interests. From the Urology Department, Urology and Nephrology Center, Faculty of Medi- cine, Mansoura University, Mansoura, Egypt; the Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; the Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt; and the Urology Department, Faculty of Medicine, Minia University, Minia, Egypt Address correspondence to: Ahmed S. El-Hefnawy, M.D., Urology Department, Urology and Nephrology Center, Voiding Dysfunction and Urodynamic Unit, Faculty of Medicine, Mansoura University, El Gomhoria Street, Mansoura 35516, Egypt. E-mail: a_s_elhefnawy@yahoo.com Submitted: October 8, 2014, accepted (with revisions): January 13, 2015 ª 2015 Elsevier Inc. All Rights Reserved http://dx.doi.org/10.1016/j.urology.2015.01.018 0090-4295/15 1039