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Botulinum toxin type A injection for refractory interstitial cystitis: A randomized comparative study and predictors of treatment response
Author(s) -
Akiyama Yoshiyuki,
Nomiya Akira,
Niimi Aya,
Yamada Yukio,
Fujimura Tetsuya,
Nakagawa Tohru,
Fukuhara Hiroshi,
Kume Haruki,
Igawa Yasuhiko,
Homma Yukio
Publication year - 2015
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12833
Subject(s) - medicine , refractory (planetary science) , interstitial cystitis , botulinum toxin , prospective cohort study , group b , cohort , randomized controlled trial , surgery , anesthesia , urinary system , physics , astrobiology
Objectives To determine whether botulinum toxin type A can represent an alternative treatment option for patients with interstitial cystitis refractory to conventional therapies. Methods This is a single‐center, prospective, open labeled, randomized comparative study. Patients with refractory interstitial cystitis were randomly divided into two groups: immediate injection (group A) or 1‐month delayed injection (group B) of botulinum toxin type A after allocation. The rate of treatment response (global response assessment ≥+1: slightly improved), and changes in symptom scores and frequency volume chart variables were compared between groups 1 month after allocation. Using subjects of both groups as a single cohort, predictive factors for treatment response at 1 month post‐injection and the duration of response were explored. Results A total of 34 patients (group A n = 18, group B n = 16) were allocated. The response rate was significantly higher in group A than group B (72.2% vs 25.0%, P = 0.01). All symptom measures showed significant improvement in group A than group B. When both groups were combined as a single cohort, the response rate was 73.5% at 1 month, 58.8% at 3 months, 38.2% at 6 months and 20.6% at 12 months. The mean duration of response was 5.4 months. Multivariate analysis showed that past exposure to hydrodistension more than three times correlated with better outcomes. Conclusions Botulinum toxin type A injection could be an alternative treatment option for patients with interstitial cystitis refractory to conventional therapies, especially for those who have received repeated hydrodistensions and transurethral fulguration.