Introduction: Reconstructive surgery is indicated in patients of intractable IC/BPS as a last resort when all other treatment options have exausted. As per present guidelines surgical options are urinary diversion with or without cystectomy, neobladder with cystectomy and surpatrigonal cystectomy with augmentation cystoplasty.All these surgries have good results but high morbidity.The current belief is that as diseased bladder is not excised in ACA, the symtoms will not improve. The aim of this study is to present our long term results and discuss why ACA is effective? Methods: From Jan 2012 we have performed ACA in 15 casses of intractable IC/BPS. 2 patients died due to causes unrelated to surgery so data from 13 patients(8 females and 5 males) were analysed and their present condition was assessed on a 7 point GRA scale. Patients with moderate and marked improvement were considered responders. The mean age was 47(23 -61) years at the time of surgery. Average pre surgery maximal bladder capacity(MBC)under anaesthesia was 290 ml(100-600).7 patients had Hunners lesion.Mean followup was 3.38 years and median was 3 years. 11 patients void with minimal residue and 2 patients need clean intermittent catheterisation. Results: 12/13 patients are resoponders in long run with 10 patients being symptomfree and 2 patietns with marked improvement as per GRA.The efficacy of ACA is maintained even in long term with the first patient being symtomfree after 10 years. The results of surgery are not affected by MBC under anaesthesia, presence and absence of hunner's lesion,severity of symptoms and duration of illness. Conclusions: Detrusor stretch plays a very important role in micturition by mechanical stimulation the bladder tension mechanoreceptors.The normal frequency/volume relationship of afferent nerve firing is modulated by the stretch-dependent release of mediators from the urothelium.Many of these mediators are increased in patients with IC/BPS , which may lower the threshold for initiation of afferent nerve firing or increase the rate of afferent nerve firing in response to bladder filling. Following ACA, there is less tension in the bladder wall at a given bladder volume because a proportion of the bladder consists of more compliant ileum increasing the threshold for afferent nerve firing which improves the symptoms.This proportion of ileum increases as bladder capacity slowly increases post surgery. ACA should be considered as an preferred option in patients of intractable IC/BPS as results are good with minimum morbidity in comparison of other more morbid surgeries. SOURCE OF Funding: none
