Botulinum A Toxin Intravesical Injections in the Treatment of Painful Bladder Syndrome: A Pilot Study

Abstract

e u r o p e a n u r o l o g y 4 9 ( 2 0 0 6 ) 7 0 4 -7 0 9 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Article info AbstractObjective: We evaluated the efficacy and tolerability of botulinum A toxin (BTX-A) intravesical injections in patients affected by painful bladder syndrome with increased urinary frequency, refractory to conventional treatment modalities. Methods: Twelve women and two men were prospectively included in the study. Under short general anaesthesia patients were given injections of 200 U of commercially available BTX-A diluted in 20 ml 0.9% NaCl. Injections were performed submucosally in the trigone and bladder floor under cystoscopic control. Voiding chart, the Visual Analog Scale (VAS) for pain, and urodynamics were performed before treatment and 1 and 3 mo afterward. Results: Overall, 12 patients (85.7%) reported subjective improvement at 1 and 3 mo follow-up. The mean VAS score was significantly reduced at 1 and 3 mo after treatment ( p < 0.05 for both); at the same time points daytime and nighttime urinary frequency significantly decreased ( p < 0.01 and p < 0.05, respectively), and bladder cystometric capacity significantly increased ( p < 0.01). Two patients reported incomplete bladder emptying. We did not detect any systemic side effects during or after treatment. Conclusions:The results of this pilot study indicate that BTX-A intravesical injections are effective in the short-term management of painful bladder syndrome. By modulating afferent C-fiber activity within the bladder walls, BTX-A significantly improves urodynamic parameters and reduces bladder pain and urinary frequency. #

Evaluation of oxidative stress status and antioxidant capacity in patients with painful bladder syndrome/interstitial cystitis: preliminary results of a randomised study

“…Although infection, autoimmune response, allergic reaction, neurogenic inflammation, and epithelial dysfunction mechanisms have been suggested in etiology, there is no general consensus on the physiopathology of the disease [21].…”

CUA guideline: Diagnosis and treatment of interstitial cystitis/ bladder pain syndrome

“…[177][178][179][180][181] Two small, double-blind RCTs have been conducted. Manning et al found no significant overall difference between patients randomized to HD plus NS injection vs. HD plus 500 U Dysport ® .…”

Intravesical instillation of botulinum toxin A: an in vivo murine study and pilot clinical trial

“…It has been well documented that intramural bladder BoNT-A injections suppress urgency in patients with neurogenic and idiopathic bladder overactivity, and the use of BoNT-A has recently been expanded to include the treatment of IC/PBS [23,24]. A number of experimental studies in rodents have provided evidence that the sensory effects of BoNT-A might be a consequence of suppression of afferent signaling.…”