Delayed contrast-enhanced MRI to localize Botox after cystoscopic intravesical injection

Alsinnawi, Mazen; Torreggiani, William C.; Sheikh, M.; Thomas, Arun Z.; Donnellan, John; Flynn, Robert J.; McDermott, Ted; Thornhill, John

doi:10.1007/s11255-015-0976-2

Cited by 17 publications

(20 citation statements)

References 21 publications

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“…T1 measurements resolve well the different layers of the bladder wall because of the signal-to-noise ratio is higher than with T2 measurements. 14 Post-contrast bladder wall T1 values of HL BPS/IC women were reduced from pre-contrast values by 44% compared to 18% for controls and non-HL BPS/IC patients, P < .0001. BPS/IC patients with HL had more gadobutrol diffusion into bladder wall compared to non-HL IC patients ( Figure 1).…”

Section: Magnetic Resonance Imagingmentioning

confidence: 79%

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How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI‐RS 2018

Khullar

Chermansky

Tarcan

et al. 2019

Neurourology and Urodynamics

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Background: This paper summarizes the discussion in a think tank at the ICI-RS 2018 about the diagnosis of bladder pain syndrome (BPS). Aims: To review the guidelines, investigations and subtypes of BPS. Materials and Methods: Review of literature in the light of the think tank discussion.Results: All guidelines recommend completing history, physical examination, urine analysis, urine culture, and urine cytology to define the BPS phenotype but there are differences on further investigations. In those guidelines which recommend cystoscopy, the identification of Hunner's lesions (HLs) is recommended as this changes the treatment plan and outcome. Conclusion: We propose that the differentiation of Hunner's ulcers is an important step in the assessment of these patients. Further suggestions for research are suggested.

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Section: Magnetic Resonance Imagingmentioning

confidence: 79%

“…Quantitative T1 measurements were calculated by taking differences in signal intensity of 20 pixels in pre‐contrast and post‐contrast images of bladder wall. T1 measurements resolve well the different layers of the bladder wall because of the signal‐to‐noise ratio is higher than with T2 measurements …”

Section: Diagnosticsmentioning

confidence: 99%

How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI‐RS 2018

Khullar

Chermansky

Tarcan

et al. 2019

Neurourology and Urodynamics

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“…37 There is a recent application that used CE-MRI to examine the distribution of Botox (botulinum toxin) with Gd-DTPA within the bladder wall after intravesical injection directly in the wall. 38 Recently we used CE-MRI to detect alterations in bladder permeability in rat bladders exposed to protamine sulfate, and also detect an increased MRI SI within the colon due to the bladder-colon crosstalk. 9 None of these studies, however, have assessed bladder crosstalk associated with colon diseases, nor has MRI been used to assess changes in permeability.…”

Section: Discussionmentioning

confidence: 99%

Assessment of colon and bladder crosstalk in an experimental colitis model using contrast‐enhanced magnetic resonance imaging

Towner

Smith

Saunders

et al. 2015

Neurogastroenterology Motil

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Background Inflammatory bowel disease (IBD) consists of two chronic remitting-relapsing inflammatory disorders in the colon referred to as ulcerative colitis (UC) and Crohn’s disease (CD). IBD affects about 1.4 million Americans. TNBS (2,4,6-trinitrobenzene sulfonic acid)-induced colitis is a widely used model of experimental intestinal inflammation with characteristic transmural and segmental lesions that are similar to CD. Methods Here we report on the use of contrast-enhanced MRI (CE-MRI) to monitor in vivo bladder permeability changes resulting from bladder crosstalk following colon TNBS exposure, and TNBS-induced colitis. Changes in MRI signal intensities and histology were evaluated for both colon and bladder regions. Key Results Uptake of contrast agent in the colon demonstrated a significant increase in signal intensity (SI) for TNBS-exposed rats (p<0.01) compared to controls. Additionally, a significant increase in bladder SI for colon TNBS-exposed rats (p<0.001) was observed compared to saline controls. Histological damage within the colon was observed, however bladder histology indicated a normal urothelium in rats with TNBS-induced colitis, despite increased permeability seen by CE-MRI. Conclusions & Inferences CE-MRI was able to quantitatively measure inflammation associated with TNBS-induced colitis, as well as assess bladder crosstalk measured as an increase in urothelial permeability. Although CE-MRI is routinely used to assess inflammation with IBD, currently there is no diagnostic test to assess bladder crosstalk with this disease, and our developed method may be useful in providing crosstalk information between organ and tissue systems in IBD patients, in addition to colitis.

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“…Magnetic resonance imaging represents a powerful non-invasive tool to track the spread of paramagnetic substances; however, onaBoNT-A is not paramagnetic and its spread cannot be directly detected by MRI. Several studies have reported mixing onaBoNT-A with gadolinium based contrast agents of different polarity, osmolarity, and chemical structure 25, 26 .…”

Section: Clinical Efficacy Of Intradetrusor Injectionmentioning

confidence: 99%

“…Alsinnawi et al injected onaBoNT-A with a macrocyclic uncharged gadolinium chelate 25 . OnaBoNT-A dosed at either 100U or 200U was reconstituted with 19 mL of 0.9% saline and 1 mL of Gadovist into either idiopathic overactive bladders or neurogenic bladders, respectively.…”

Section: Clinical Efficacy Of Intradetrusor Injectionmentioning

confidence: 99%

Past, Present and Future of Chemodenervation with Botulinum Toxin in the Treatment of Overactive Bladder

et al. 2017

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Purpose We systematically reviewed both pre-clinical and clinical studies on bladder chemodenervation with onabotulinumtoxin A to highlight current limitations and future drug delivery approaches. Materials and Methods We identified peer-reviewed basic and clinical research studies of onabotulinumtoxin A (onaBoNT-A) in the treatment of neurogenic bladder and refractory idiopathic overactive bladder (OAB) published between March 2000 and March 2016. Paired investigators independently screened 125 English language articles to identify controlled studies on onaBoNT-A administration in MEDLINE® database and abstracts presented at annual American Urological Association meetings. The review yielded an evidence base of over 50 articles relevant to the approach of injection free onaBoNT-A chemodenervation. Results The efficacy and safety of intradetrusor injection of onaBoNT-A for the treatment of OAB is sensitive to both injection volume and depth, and this issue has motivated researchers to study injection-free modes of drug delivery into the bladder. Urothelial denudation with protamine sulfate or dimethyl sulfoxide (DMSO), liposome encapsulated onaBoNT-A, and other physical approaches are all being studied to increase toxin permeability and avoid intradetrusor injections. Liposome encapsulated onaBoNT-A enhances toxin activity while reducing its toxin degradation. The safety and efficacy of liposome encapsulated onaBoNT-A was tested in a multi-center, placebo controlled study. Although this treatment successfully reduced urinary frequency and urgency, it did not significantly reduce urgency urinary incontinence episodes. Conclusions Intradetrusor injection of onaBoNT-A is safe and effective as reported in several large multicenter randomized controlled trials. Injection of the toxin into the bladder wall impairs both afferent and efferent nerves, but drug delivery approaches that avoid injections impair only bladder afferent nerves. Further studies are needed to develop better drug delivery platforms that overcome the drawbacks of intradetrusor injection, increase patient acceptance, and reduce the treatment costs.

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Delayed contrast-enhanced MRI to localize Botox after cystoscopic intravesical injection

Cited by 17 publications

References 21 publications

How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI‐RS 2018

How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI‐RS 2018

Assessment of colon and bladder crosstalk in an experimental colitis model using contrast‐enhanced magnetic resonance imaging

Past, Present and Future of Chemodenervation with Botulinum Toxin in the Treatment of Overactive Bladder

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