The use of botulinum toxin for the treatment of urologic pain (original) (raw)
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European Urology, 2006
We evaluated the efficacy and tolerability of botulinum A toxin (BTX-A) intravesical injections in patients affected by painful bladder syndrome with increased urinary frequency, refractory to conventional treatment modalities.Twelve women and two men were prospectively included in the study. Under short general anaesthesia patients were given injections of 200 U of commercially available BTX-A diluted in 20 ml 0.9% NaCl. Injections were performed submucosally in the trigone and bladder floor under cystoscopic control. Voiding chart, the Visual Analog Scale (VAS) for pain, and urodynamics were performed before treatment and 1 and 3 mo afterward.Overall, 12 patients (85.7%) reported subjective improvement at 1 and 3 mo follow-up. The mean VAS score was significantly reduced at 1 and 3 mo after treatment (p < 0.05 for both); at the same time points daytime and nighttime urinary frequency significantly decreased (p < 0.01 and p < 0.05, respectively), and bladder cystometric capacity significantly increased (p < 0.01). Two patients reported incomplete bladder emptying. We did not detect any systemic side effects during or after treatment.The results of this pilot study indicate that BTX-A intravesical injections are effective in the short-term management of painful bladder syndrome. By modulating afferent C-fiber activity within the bladder walls, BTX-A significantly improves urodynamic parameters and reduces bladder pain and urinary frequency.
Botulinum Toxin Therapy for Bladder Pain Syndrome/Interstitial Cystitis
Current Bladder Dysfunction Reports
Purpose of Review Bladder pain syndrome (BPS)/interstitial cystitis (IC) can also be classified as either non-ulcerative or ulcerative, corresponding to the characteristic cystoscopic findings under hydrodistention. Promising therapeutic effects, including decreased bladder pain, have been reported from recent clinical trials using botulinum toxin A (BoNTA) for the treatment of BPS/IC. This review summarizes the current state of the literature on the underlying mechanisms of BoNTA therapy in BPS/IC as well as new forms of its application. Recent Findings BoNTA has its effect in the central nervous system in the afferent nerves as well as in the bladder wall. Besides the well-known effects of BoNTA in the nervous system, pain control as well as reduction of urinary urgency in BPS patients could be achieved by mast cell stabilization effecting histamine release as well as modulation of TRPV and PGE2 pathways, among other systems. In addition, new forms of BoNTA administration have foc...
European Urology, 2010
E U R O P E A N U R O L O G Y X X X ( 2 0 1 0 ) X X X -X X X a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m 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.
American journal of clinical and experimental urology, 2019
Botulinum toxins were primary suggested for the neurogenic lower urinary tract dysfunction (LUTD) treatment about thirty years ago. The application of BTX-A in LUTD have just developed and the approval of BTX-A injection confirmed in for patients with both overactive bladders (OAB) and neurogenic detrusor overactivity (NDO). Actually the BTX-A medication in interstitial cystitis/bladder pain syndrome (IC/BPS) is not licensed, but there is under consideration. Despite BTX-A is recommended to treat patients with interstitial cystitis/bladder pain syndrome (ICBPS) under different occasions, its efficacy and safety in the cure of (IC/BPS) is under consideration. One difficulty is related to the toxin delivering systems. It is shown that there is no difference in BTX-A injection to body or trigone but there is a need on further large-scale studies over this subject. Moreover, Hydro distention can boost the therapeutic effect of BTX-A for IC/BPS patients. Additional studies should conside...
Botulinum A Toxin Intravesical Injection in Patients With Painful Bladder Syndrome: 1Year Followup
Journal of Urology, 2008
We evaluated the 1-year efficacy and tolerability of botulinum A toxin intravesically injected in patients with painful bladder symptoms associated with increased urinary frequency, refractory to conventional treatments. Materials and Methods: Three men and 12 women were prospectively included in the study. Under short general anesthesia the patients were given injections of 200 U commercially available botulinum A toxin diluted in 20 ml 0.9% NaCl. Injections were performed submucosally in the bladder trigone and lateral walls under cystoscopic guidance. A voiding chart and the visual analog scale for pain were used, and urodynamics were performed before treatment, and 1, 3, 5 and 12 months later. Results: Overall 13 patients (86.6%) reported subjective improvement at the 1 and 3-month followups. The mean visual analog scale score, and daytime and nighttime urinary frequency were significantly decreased (p Ͻ0.05, Ͻ0.01 and Ͻ0.05, respectively). At the 5-month followup the beneficial effects persisted in 26.6% of cases but increased daytime and nighttime urinary frequency, and an increased visual analog scale score were observed compared to baseline. At 12 months after treatment pain recurred in all patients. Nine patients complained of dysuria 1 month after treatment. Dysuria persisted in 4 cases at the 3-month followup and in 2 at the 5-month followup. Conclusions: Intravesically injected botulinum toxin A is effective for short-term management of refractory painful bladder syndrome. The beneficial effects decreased progressively within a few months after treatment. Thus, repeat injections of the neurotoxin are required for efficacious treatment in patients with the disease.
Current Drug Delivery, 2010
Introduction and Aim: We report the 2-year efficacy and tolerability of intravesical botulinum A toxin (BoNT/A) injections in patients with painful bladder syndrome (PBS) associated with increased urinary frequency refractory to conventional treatments. Materials and Methods: Thirteen women were prospectively included in the study. The preliminary assessment included voiding diary, urodynamics, urinary tract ultrasound and the visual analog scale (VAS) for pain quantification. All patients received multiple injections of 200 U commercially available BoNT/A diluted in 20 ml 0.9% NaCl, under cystoscopic guidance. Clinical evaluation, urodynamics, urinary tract ultrasound and VAS were repeated at least two times per year throughout the follow-up. Results: A total of 58 injections were administered with a mean of 4.8 ± 0.8 injections per patient. The mean interval between two consecutive injections was 5.25 ± 0.75 months. At 1 and 4 mo follow up ten patients reported a subjective improvement. Mean VAS scores, mean daytime and night-time urinary frequency decreased significantly. Nine patients at 1 month and seven at the 4-month checkup complained of dysuria. The three non-responders to the first intravesical treatment session underwent another three months later with satisfactory results. At 1 and 2 years follow up the beneficial effects persisted in all patients. We did not observe any systemic side effects during the observation time. Conclusions: Intravesically injected BoNT/A is effective and safe in the medium-term management of patients with PBS. As the beneficial effect decreased progressively within a few months after treatment, repeat injections of the neurotoxin were needed over time.
F1000 - Post-publication peer review of the biomedical literature
Botulinum neurotoxin (BoNT) is used to treat a variety of ailments, and its therapeutic application in lower urinary tract disorders (LUTDs) is well studied. Robust evidence supporting the efficacy and tolerability of BoNT in the treatment of neurogenic detrusor overactivity (NDO) and non-neurogenic overactive bladder (OAB) has led to regulatory approval for these conditions. Use of BoNT in the treatment of interstitial cystitis/bladder pain syndrome, chronic pelvic pain, and detrusor sphincter dyssynergia has demonstrated some promise, but is still evolving and off-label for these indications. Trials to date do not support the use of BoNT for benign prostatic hyperplasia. This comprehensive review outlines the mechanisms of BoNT in the treatment of LUTDs in adults and presents background and updated data examining the efficacy and adverse events associated with the use of BoNT in common urologic applications.
Current Status of Botulinum Toxin for Neurogenic Bladder Dysfunction
Current Bladder Dysfunction Reports, 2010
With 10 years of use completed since the first bladder injection, an increasing body of evidence supports the efficacy of intradetrusally injected botulinum neurotoxin type A to treat intractable symptoms of neurogenic detrusor overactivity in adults. Highly significant improvements in patients' symptoms, urodynamic parameters and quality of life, sustained with repeat injections and with few transient side effects have been consistently reported, leading to high-grade recommendations for its use in refractory adult neurogenic detrusor overactivity. Cautions have been raised when it is used in children, in whom efficacy has been shown in open-label studies. Large, placebo-controlled trials are awaited, as is further investigation into long-term safety.