Postsurgery Opiate Use Is Significantly Lower in Patients With Interstitial Cystitis/Bladder Pain Syndrome Following Cystectomy With Urinary Diversion

Abstract

Introduction and Objective

Opiates are often prescribed for pain management in interstitial cystitis/bladder pain syndrome (IC/BPS) patients and those with end-stage bladder disease may elect to undergo cystectomy with urinary diversion (CWUD) for relief of pain and improved quality of life. In this study we compared pre- and post-operative opiate use in a large cohort of IC/BPS patients who underwent CWUD.

Methods

A retrospective analysis was completed using a database of IC/BPS patients who underwent CWUD at a single institution from 2014 to 2022. In addition to demographic information, bladder capacity (BC) and Hunner lesion (HL) status were documented for each patient. Opiate use (milligram morphine equivalents (MME)) was calculated for each patient and change in MME (ΔMME) was calculated by subtracting pre-CWUD MME from post-CWUD MME. Paired t-test was used to compare ΔMME for all parameters except age, where a Pearson's correlation was used.

Results

The analysis included 82 patients (17 M; 65 F) that underwent CWUD as follows: 53 ileal conduit diversions, 11 neobladders, and 18 Indiana Pouches. Mean pre-CWUD MME use was 4509.57 and mean post-CWUD MME was 1788.48 with a ΔMME of -2721.09 (p<0.001). ΔMME was not significantly different based on gender (p=0.597), BC (p=0.754), age (p=0.561), or HL status (p=0.085).

Conclusions

IC/BPS patients using opiates primarily for relief of pain directly related to their condition show a significant decrease in opiate use following CWUD, which likely represents significant pain reduction and implicates the bladder as the primary source of that pain.