Botulinum A Toxin Intravesical Injection In Patients With Painful Bladder Syndrome: 1-Year Followup

Main Category: Urology / Nephrology
Article Date: 13 Jun 2008 - 3:00 PDT

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The exact mechanism of the analgesic effect of Botulinum toxin type A (BoNT/A) is poorly understood. It has been shown to have an antinociceptive effect on bladder tissue in animal chemical cystitis models, and in patients with BPS/IC, perhaps mediated by the block of the release of several neurotransmitters involved in afferent nociceptive transmission. Giannantoni and colleagues from Perugia, Italy performed a longitudinal study to look at the 1 year efficacy and tolerability of BoNT/A submucosal injections in patients with painful bladder symptoms associated with urinary frequency that were refractory to conventional treatments.

Fifteen patients were injected with 200 units BoNT/A diluted in 20cc normal saline into the lateral walls of the bladder and trigone. Thirteen patients reported subjective improvement at 1 month and 3 months of followup. At 5 months the beneficial effects persisted in only 26.6% of patients, but with increased daytime and nighttime urinary frequency and an increased visual analog scale score for pain compared to baseline. Pain recurred in all patients at the one year post-treatment mark, and clinical an urodynamic parameters all returned to baseline. Nine of the 15 patients had dysuria 1 month after treatment, and this persisted in 4 cases at 3 months and in 2 cases at 5 month followup.

Despite the injection route being submucosal, impaired detrusor contractility was noted in 9 of the 15 patients 1 month after treatment. Three patients required intermittent catheterization. The authors conclude that using their technique of injection, patients should be informed that they likely will need repeat procedures at 6 month intervals. This makes this procedure somewhat expensive, and prohibitive in many patients until and unless it is covered for BPS/IC by health insurance.

Giannantoni A, Porena M, Costantini E, Zucchi A, Mearini L, Mearini E

J Urol. 2008 Mar;179(3):1031-4
doi: 10.1016/j.juro.2007.10.032

Reported by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

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