Predictive Factors for a Satisfactory Treatment Outcome with Intravesical Botulinum Toxin A Injection in Patients with Interstitial Cystitis/Bladder Pain Syndrome

Abstract

A botulinum toxin A (BoNT-A) intravesical injection can improve the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Patients with IC/BPS have different clinical characteristics, urodynamic features, and cystoscopic findings. This study assessed the treatment outcomes of a BoNT-A intravesical injection and aimed to identify the predictive factors of a satisfactory outcome. This retrospective study included IC/BPS patients treated with 100 U BoNT-A. The treatment outcomes were assessed by global response assessment (GRA) at 6 months. We classified patients according to different clinical, urodynamic, and cystoscopic characteristics and evaluated the treatment outcomes and predictive factors. A total of 238 patients were included. Among these patients, 113 (47.5%) had a satisfactory outcome (GRA ≥ 2) and 125 (52.5%) had an unsatisfactory outcome. Improvements in the IC symptom score, IC problem score, O’Leary–Sant symptom score, and visual analog scale score for pain were significantly greater in patients with a satisfactory outcome than in patients with an unsatisfactory outcome (all p = 0.000). The IC disease duration and maximal bladder capacity (MBC) were significantly different between patients with and without a satisfactory outcome. Multivariate analysis revealed that only the MBC was a predictor for a satisfactory outcome. Patients with a MBC of ≥760 mL and glomerulations of 0/1 (58.7%) or glomerulations of 2/3 (75.0%) frequently had a satisfactory outcome. We found that BoNT-A intravesical injection can effectively improve symptoms among patients with IC/BPS, with a remarkable reduction in bladder pain. A MBC of ≥760 mL is a predictive factor for a satisfactory treatment outcome.

Notch1 Signaling Contributes to Mechanical Allodynia Associated with Cyclophosphamide-Induced Cystitis by Promoting Microglia Activation and Neuroinflammation

“…Furthermore, it also inspires us that the treatment outcome could somehow depend on the disease duration in BPS/IC patients. For example, the treatment outcomes of botulinum toxin A are different between IC/BPS patients with different disease duration [25]. The main limitation of our present study is that we only focus on the Notch1 receptor in Notch1 signaling without involving the ligands of Notch1 signaling, including Jagged and Delta.…”

“…Furthermore, it also inspires us that the treatment outcome could somehow depend on the disease duration in BPS/IC patients. For example, the treatment outcomes of botulinum toxin A are different between IC/BPS patients with different disease duration [ 25 ].…”

Therapeutic Efficacy of Intravesical Platelet-Rich Plasma Injections for Interstitial Cystitis/Bladder Pain Syndrome—A Comparative Study of Different Injection Number, Additives and Concentrations

“…All patients were informed of the possible complications associated with intravesical PRP injection, such as hematuria, micturition pain, difficult urination, transient urinary retention, or urinary tract infections (UTIs). Treatment outcomes were assessed using the GRA at 3 and 6 months after the first PRP injection ( Wang et al, 2019 ).…”

Urinary Biomarkers in Interstitial Cystitis/Bladder Pain Syndrome and Its Impact on Therapeutic Outcome

“…BoNT-A can relieve pain, urgency, and frequency for refractory IC/BPS and improve the functional bladder capacity [ 198 , 199 ]. Kuo et al suggested that functional bladder capacity (136 ± 79.1 vs. 208 ± 110, p = 0.000) was significant improvement after four repeated injections with BONT- A in IC/BPS patients.…”