**4. Reconstructive surgery**

Partial or complete cystectomy, augmentation cystoplasty, and urinary diversion are options indicated by the AUA and East Asian guidelines when all other therapies have failed [1, 7]. Rossberger et al. [26] found that reconstructive surgery resulted in the resolution of symptoms in 94% of patients with refractory IC/BPS with Hunner lesion. Patients with IC/BPS with Hunner lesion had a significantly smaller bladder capacity and benefited from reconstructive surgery compared with patients without Hunner lesion. We retrospectively analyzed 40 patients who underwent augmentation ileocystoplasty with supratrigonal cystectomy in patients with refractory IC/BPS with Hunner lesion [27]. After augmentation with supratrigonal cystectomy, significantly decreased pain and frequency and significantly increased bladder capacity were observed. Treatment failure was defined as the persistence of symptoms after surgery or a less than 30% reduction in ICSI from baseline, which accounted for 20% (8/40) of patients. Two of the patients had recurrent Hunner lesion around the bladder neck and additional endoscopic ablation was performed, while the remaining patients maintained oral medication [27]. *Management of Hunner Lesion in Interstitial Cystitis/Bladder Pain Syndrome Patients DOI: http://dx.doi.org/10.5772/intechopen.100052*

There may be concerns about major complications after reconstructive surgery; however, most complications were minor and managed conservatively. Although six patients had vesicoureteral reflux after surgery, there was no deterioration of the upper urinary tract, so no additional treatment was required. Five patients received intermittent catheterization because they were unable to void after surgery, but the discomfort of catheterization was not considered a significant problem due to improvement in pain [27].
