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. #

Resiniferatoxin and botulinum toxin type A for treatment of lower urinary tract symptoms

“…However, 10 patients experienced moderate to severe difficulties when attempting to empty their bladders. 55 Other studies, however, could not find any effect of BTX-A in IC/PBS. At the 2006 EAU meeting, Davies et al 56 presented results from a study of 13 patients with IC/PBS treated with BTX-A 100-300 U; 1 patient was reported cured, partial improvement was detected in 3 patients, and 9 patients worsened.…”

“…Additionally, first desire to void and MCC increased by 58% and 57%, respectively. 54 In another pilot study, Giannantoni et al 55 concluded that intravesical BTX-A 200 U is effective in the short-term management of IC/PBS. Twelve of 14 patients (86%) reported subjective improvement at the 1-and 3-month follow-up point.…”

Botulinum toxin treatment for bladder dysfunction

“…Therefore, several small pilot studies were immediately carried out, none were placebo controlled, to explore the analgesic effects of onabotA in patients with chronic bladder pain as a result of BPS/IC. Unfortunately, conflicting results or weak and transient clinical improvements were reported . A prospective, randomized study enrolled 67 patients with refractory BPS/IC.…”

The use of botulinum toxin for the treatment of urologic pain

“…All of these studies involve patients who have failed at least one conventional treatment for BPS/ interstitial cystitis. Giannantoni et al [26] subsequently reported on the use of Ona-botulinumtoxinA in 14 patients, who had previously failed oral antidepressant, anticholinergic therapy or intravesical treatments of oral pentosan polysulphate. This study used doses of up to a maximum of 200 IU of both OnabotulinumtoxinA and AbobotulinumtoxinA, and utilized a trigone and floor of the bladder injection technique.…”