Background <p>Interstitial cystitis (IC), particularly in patients with Hunner-type lesions, is a chronic, debilitating condition with limited treatment success. While bladder fulguration and pentosan polysulfate sodium (PPS, Elmiron) are established treatments, their combined efficacy has not been systematically studied.</p> Objective <p>To evaluate whether adjunctive Elmiron therapy enhances the therapeutic outcomes of fulguration in female patients with Hunner-type IC.</p> Methods <p>A total of 97 female patients with Hunner-type IC who underwent bladder fulguration between 2022 and 2024 were included in this retrospective analysis of prospectively collected data. Group 1 (<i>n</i> = 49) received Elmiron therapy for 6 months postoperatively, while Group 2 (<i>n</i> = 48) did not. Patients were followed for 12 months, and outcomes were assessed using the Visual Analogue Scale (VAS), Interstitial Cystitis Symptom Index (ICSI), and Interstitial Cystitis Problem Index (ICPI).</p> Results <p>No statistically significant differences were observed between groups in VAS scores at any time point. However, Group 1 showed a significantly greater reduction in ICSI scores at 12 months (<i>p</i> = 0.023) and in ICPI scores at both 6 months (<i>p</i> = 0.040) and 12 months (<i>p</i> &lt; 0.001). Percentage change analyses confirmed a more pronounced improvement in symptom and problem indices in the Elmiron group at 12 months.</p> Conclusion <p>Adjunctive Elmiron therapy appears to enhance the long-term symptom and problem index outcomes of fulguration in women with Hunner-type interstitial cystitis. Further large-scale, multicenter studies are warranted to optimize treatment protocols and establish standardized guidelines for this combination approach.</p>