**3.5 Is it helpful to perform concurrent hydrodistension before transurethral ablation?**

Some studies have suggested that concurrent hydrodistension with transurethral ablation may be helpful for symptom improvement [16, 18, 25]. However, the simultaneous performance of hydrodistension causes difficulties in complete removal of the Hunner lesion. Hydrodistension obscures the boundaries of the Hunner lesion, which are clearly identified through cystoscopy, and bleeding related to hydrodistension interferes with the field of surgical view. We believe that good efficacy can be maintained only with transurethral resection or coagulation of Hunner lesion without hydrodistension.
