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Trigonal injection of botulinum toxin A in patients with refractory bladder pain syndrome/interstitial cystitis.

Abstract：

BACKGROUND:Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease without an effective treatment, characterized by pain during bladder filling. Most nociceptive bladder afferents course in the trigone. OBJECTIVE:To evaluate efficacy and tolerability of trigonal injection of botulinum toxin A (BoNTA) in patients with BPS/IC. Urine concentration of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were also evaluated. DESIGN, SETTING, AND PARTICIPANTS:Women with refractory BPS/IC were included in an open, exploratory study. INTERVENTION:Under sedation, 100 U of BoNTA (Botox) were injected in 10 trigonal sites (10 U per 1 ml saline). Retreatment was allowed 3 mo after injection. MEASUREMENTS:Pain, urinary frequency, O'Leary-Sant score (OSS), quality of life, (QoL), and urodynamic testing at 1 and 3 mo and every 3 mo thereafter. Urine NGF and BDNF were assessed at the same points. Patients who were retreated were evaluated every 3 mo. RESULTS AND LIMITATIONS:All patients reported subjective improvement at 1- and 3-mo follow-up. Pain, daytime and nighttime voiding frequency, OSS, and QoL improved significantly. Bladder volume to first pain and maximal cystometric capacity more than doubled. Treatment remained effective in >50% of the patients for 9 mo. Retreatment was also effective in all cases, with similar duration. A significant, transient reduction in urinary NGF and BDNF was observed. No cases of voiding dysfunction occurred. The low number of patients and the lack of a placebo arm are obvious limitations of this study. CONCLUSIONS:Trigonal injection of BoNTA is a safe and effective treatment for refractory BPS/IC.

journal_name

Eur Urol

journal_title

European urology

authors

Pinto R,Lopes T,Frias B,Silva A,Silva JA,Silva CM,Cruz C,Cruz F,Dinis P

doi

10.1016/j.eururo.2010.02.031

subject

Has Abstract

pub_date

2010-09-01 00:00:00

pages

360-5

issue

3

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(10)00203-4

journal_volume

58

pub_type

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