Efficacy of botulinum toxin A for the treatment of bladder pain syndrome: A systematic review

Abstract

ObjectivesTo determine the efficacy and safety of BTX-A, compared with other interventions for the treatment of BPS to improve quality of life. MethodsThis systematic review fulfills all the requirements of the Cochrane manual and PRISMA reporting guidelines. The PROSPERO registration number is: CRD42016039480. Clinical trials without language discrimination were included. BPS patients over 18 y/o that were treated with BTX-A were included. Studies were searched in published databases and no published literature from inception to the present day. Risk of bias analysis was done using the Cochrane risk of bias tool. Results88 articles were found with the designed search strategies. After exclusions, four studies were included in the qualitative analyses. Kasyan et al. (2012) compared BTX-A with hydrodistention. Manning et al. (2014) compared the injection of BTX-A with the injection of normal saline in previously hydrodistended bladders. In both cases, primary end point was measured by the O’Leary-Sant questionnaire score. El-Bahnasy et al. (2009) compared BTX-A with BCG administration, through Global Response Assessment. Kuo et al. (2015) compared hydrodistention plus suburothelial injections of BTX-A with hydrodistension plus normal saline injections. Reduction in pain was estimated by VAS bladder pain score. A similar efficacy to their controls had been found in Kasyan and Manning studies. El-Bahnasy had found improvement in BTX-A in all parameters. Kuo et al. (2015) found a significantly reduction in pain in the BTX-A group. Regarding the risk of bias, three studies did not have adequate descriptions of selection, performance and detection bias. The study of Manning had low risk of selection, attrition and reporting bias. ConclusionThere is not enough evidence to conclude the efficacy of BTX-A for the treatment of interstitial cystitis to improve quality of life.