Treating Lower Urinary Tract Symptoms in Older Adults: Intravesical Options

Ganguly, Anirban; Tyagi, Shachi; Chermansky, Christopher; Beckel, Jonathan M.; Hashimoto, Mamoru; Cho, Kang Jun; Chancellor, Michael B.; Kaufman, Jonathan; Yoshimura, Naoki; Tyagi, Pradeep

doi:10.1007/s40266-023-01009-5

Cited by 4 publications

(2 citation statements)

References 192 publications

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“…Repeat BoNT-A injections may result in a durable satisfactory outcome. Additionally, in treating lower urinary symptoms in patients with OAB, not only is the concentration administered through oral intake lower than that drug instilled intravesically, but intravesical instillation of anti-muscarinic treatment can reduce systemic adverse events in elderly patients [ 41 ]. When we point to the intravesical BoNT-A with bladder volume, BoNT-A’s impact on muscle paralytic function and its ability to alleviate bladder spasms by reducing involuntary contractions and enhancing overall bladder volume might positively influence voiding volume in individuals suffering from IC/BPS.…”

Section: Discussionmentioning

confidence: 99%

Intravesical Botulinum Toxin Injection Plus Hydrodistention Is More Effective in Patients with Bladder Pain-Predominant Interstitial Cystitis/Bladder Pain Syndrome

Yu,

Jhang,

Kuo

2024

Toxins

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Intravesical botulinum toxin A (BoNT-A) injections are included in the interstitial cystitis/bladder pain syndrome (IC/BPS) treatment guidelines. However, the IC phenotype suitable for treatment with BoNT-A has not been clarified. Therefore, we identified the factors influencing treatment outcomes for intravesical BoNT-A injections in patients with non-Hunner IC/BPS (NHIC). This retrospective study included patients with NHIC who underwent 100 U BoNT-A intravesical injections over the past two decades. Six months after treatment, treatment outcomes were assessed using the Global Response Assessment (GRA). Outcome endpoints included GRA, clinical symptoms, urodynamic parameters, urine biomarkers, and the identification of factors contributing to satisfactory treatment outcomes. The study included 220 patients with NHIC (42 men, 178 women). The satisfactory group (n = 96, 44%) had significantly higher pain severity scores and IC symptoms index, larger maximum bladder capacity (MBC), and lower 8-isoprostane levels at baseline. Logistic regression revealed that larger MBC (≥760 mL) and bladder pain predominance were associated with satisfactory outcomes after BoNT-A injection. Subjective parameters and pain severity scores improved significantly in patients with bladder pain-predominant IC/BPS after BoNT-A injection. Thus, NHIC patients with bladder or pelvic pain are more likely to experience satisfactory outcomes following intravesical BoNT-A injections.

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Section: Discussionmentioning

confidence: 99%

Intravesical Botulinum Toxin Injection Plus Hydrodistention Is More Effective in Patients with Bladder Pain-Predominant Interstitial Cystitis/Bladder Pain Syndrome

Yu,

Jhang,

Kuo

2024

Toxins

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“…Moreover, the systemic uptake of pembrolizumab into bladder mucosa after intravesical administration for ≥30 min is assured by the tumoritropic infiltration of macromolecules of comparable size such as radiolabeled dextran-99mTechnetium conjugated to epidermal growth factor (EGF) after 30 min instillation in non-muscle invasive BC patients [32]. Not only is the Stokesian diffusion of macromolecules-BCG, pembrolizumab and EGF conjugated probe (Figure 1)-slower than that of smaller molecules like Mitomycin [molecular weight 334.3 Daltons, partition coefficient (log P)-0.4] [ [33][34][35] Gadobutrol [2,36] or fluorescein [37] but the extravasation of diffused macromolecules into capillaries and veins is slower than small molecules. As a result, fast venous clearance of Mitomycin [33,34], Gadobutrol [38] or Fluorescein [37] prevents their excessive buildup in the lesioned areas whereas slow lymphatic clearance of macromolecules [39] engenders a 2.4-1710-fold uptake of EGF conjugated probe relative to normal areas which reproduced the excessive buildup of labeled antibodies in transected lesions [32,40,41].…”

Section: Toxicity Associated With Intravesical Immune Checkpoint Inhi...mentioning

confidence: 99%

Enhancing Therapeutic Efficacy and Safety of Immune Checkpoint Inhibition for Bladder Cancer: A Comparative Analysis of Injectable vs. Intravesical Administration

Tyagi,

Hafron,

Kaufman

et al. 2024

IJMS

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Bladder cancer (BC) presents a significant global health burden, characterized by high recurrence rates post-initial treatment. Gender differences in BC prevalence and response to therapy emphasize the importance of personalized treatment strategies. While Bacillus Calmette–Guérin (BCG) remains a cornerstone of BC therapy, resistance poses a challenge, necessitating alternative strategies. Immune checkpoint inhibitors (ICIs) have shown promise, yet systemic toxicity raises concern. Intravesical administration of ICIs offers a potential solution, with recent studies demonstrating the feasibility and efficacy of intravesical pembrolizumab. Although systemic toxicity remains a concern, its localized administration may mitigate adverse events. Additionally, liposomal delivery of ICIs exhibits promises in enhancing drug penetration and reducing toxicity. Novel imaging modalities compatible with Vesical Imaging-Reporting and Data System (VI-RADS) and capable of predicting high-grade bladder cancer can aid the pre-operative shared decision making of patient and surgeon. Future research should focus on refining treatment approaches, optimizing dosing regimens, and leveraging advanced imaging techniques to improve patient outcomes. In conclusion, intravesical immunotherapy presents a promising avenue for BC treatment, offering enhanced therapeutic effectiveness while minimizing systemic toxicity. Continued research efforts are essential to validate these findings and optimize intravesical immunotherapy’s role in BC management, ultimately improving patient outcomes.

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Unraveling the complexity of bladder-centric chronic pain by intravesical contrast enhanced MRI

et al. 2023

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Treating Lower Urinary Tract Symptoms in Older Adults: Intravesical Options

Cited by 4 publications

References 192 publications

Intravesical Botulinum Toxin Injection Plus Hydrodistention Is More Effective in Patients with Bladder Pain-Predominant Interstitial Cystitis/Bladder Pain Syndrome

Intravesical Botulinum Toxin Injection Plus Hydrodistention Is More Effective in Patients with Bladder Pain-Predominant Interstitial Cystitis/Bladder Pain Syndrome

Enhancing Therapeutic Efficacy and Safety of Immune Checkpoint Inhibition for Bladder Cancer: A Comparative Analysis of Injectable vs. Intravesical Administration

Unraveling the complexity of bladder-centric chronic pain by intravesical contrast enhanced MRI

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