Operational procedure
Hunner’s lesions, congestion, bleeding, tumour
BLEEDING, HUNNER, CONGESTION, TUMOUR, CAVITY, BLADDER, URETHRA
After the induction of anaesthesia, patients were placed in the lithotomy position. A 30°-angled cystoscope was inserted through the urethra to drain the bladder of all urine. Hunner’s lesions were identified and thoroughly inspected under the cystoscope, and their location, number, and area were noted. Bladder hydrodistention was then performed by filling the bladder with normal saline by gravity from a height of 80 cm above the pubic symphysis. Maximum filling in the bladder was maintained for 8 min, and the maximum bladder volume was recorded. Changes in Hunner’s lesions and glomerulation were observed while the saline was drained. Bladder biopsy was performed and the bleeding area, including the mucosal crack, was cauterized to control bleeding. The hyperaemic and congestion areas with Hunner’s lesions were also coagulated. After confirming that there was no bleeding, the surgeon inserted a 6.6-mm three-way catheter for postoperative continuous irrigation. A bimanual examination was performed to check whether any tumour was present in the pelvic cavity, and the surgery was terminated. The entire procedure was performed by a single surgeon (SJO) with the assistance of an attending urologist (YJK).