Open AccessRepeated Onabotulinumtoxin-A Injections Provide Better Results than Single Injection in Treatment of Painful Bladder Syndrome
Author(s) -
HannChorng Kuo
Publication year - 2013
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2013/16/e15
Subject(s) - medicine , visual analogue scale , single center , interstitial cystitis , anesthesia , bladder pain syndrome , prospective cohort study , surgery , urinary system
Background: Onabotulinumtoxin-A (BoNT-A) is effective for the treatment of interstitialcystitis/painful bladder syndrome (IC/PBS). However, long-term follow-up does not showsuccessful outcome after a single injection.Objectives: To evaluate the efficacy and safety of repeated intravesical BoNT-A injections fortreatment of IC/PBS and compare the success rates among patient groups receiving differentinjection numbers.Study Design: Prospective interventional study.Setting: Tertiary medical center.Methods: Intravesical injection of 100 U of BoNT-A was performed in 81 patients every 6months for up to 4 times or until patients’ symptoms significantly improved. Patients whoreceived a single injection served as active controls. Measured parameters included O’LearySant symptom indexes (ICSI) and problem indexes (ICPI), visual analogue score (VAS) for pain,voiding diary variables, urodynamic parameters, maximal bladder capacity under anesthesia,glomerulation grade, and global response assessment. Multiple measurements and KaplanMeier analysis were used for comparison of consecutive data and success rates among groups.Results: Among 81 patients, 20 received single injections, 19 received 2 injections, 12received 3 injections, and 30 received 4 injections. The mean (± standard deviation) of ICSI, ICPI,total scores, VAS, functional bladder capacity, and daytime frequency all showed significantimprovement after repeated BoNT-A treatment with different injections. Significantly bettersuccess rates were noted in patients who received 4 repeated injections (P = 0.0242) and 3injections (P = 0.050), compared to those who received a single injection. However, there wasno significant difference of long-term success rates among patients who received 2, 3, and 4injections.Limitations: Lack of placebo control group is the main limitation.Conclusion: Repeated intravesical BoNT-A injections were safe and effective for pain reliefand they increased bladder capacity and provided a better long-term success rate than a singleinjection did for treatment of IC/PBS.Key words: Botulinum toxin, IC/PBS, Intravesical treatment