HUNNER'S ULCER

Abstract

SUMMARY Hunner's ulcer is a rare condition; only twenty‐seven definite cases have been seen at St Peter's and St Paul's hospitals in the last ten years. During this period forty‐two patients were classified as having this condition. The average age was 53, and all but two were women. The symptoms common to the whole group were frequency and pain when the bladder was full. and these were temporarily relieved by hydrostatic dilatation of the bladder. The urine was always sterile. The cystoscopic appearances, although insignificant in comparison with the symptoms, were specific and were found only in the free part of the bladder. Treatment is discussed. Conservative therapy, apart from dilatation, was not effective. Ureterosigmoidostomy was performed ten times with two deaths; the surviving patients obtained complete relief. Ileocystoplasty was carried out three times, but its value is difficult to assess. It appears that either the stoma has to be very wide or extensive partial cystectomy has to be performed for relief of symptoms. The differential diagnosis is from tuberculous and other forms of chronic cystitis. and carcinoma of the bladder. Hunner's ulcer is only one form of chronic interstitial cystitis. The letiology is still unknown and the possible causes are discussed. It is not likely to be infective, but may be due to hormonal influences and may be partly psychosomatic. The pathology is quite non‐specific.