Abstract

Intravesical onabotulinumtoxinA (BoNT-A) injection can relieve symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS), but lacks sustainability. Repeated injections have been shown to provide a superior outcome to a single injection, but data on long-term efficacy and safety is limited. In this prospective study, we enrolled patients with refractory IC/BPS, and treated them with 100 U of BoNT-A injection plus hydrodistention followed by repeated injections every six months for up to two years or until the patient wished to discontinue. A “top-up” dose was offered after the fourth injection. Of these 104 participants, 56.7% completed four BoNT-A injections and 34% voluntarily received the fifth injection due to exacerbated IC symptoms. With a follow-up period of up to 79 months, O’Leary-Sant symptom and problem indexes (ICSI, ICPI, OSS), pain visual analogue scale (VAS) functional bladder capacity, frequency episodes, and global response assessment (GRA) all showed significant improvement (p < 0.0001). Those who received repeated injections had a better success rate during the long-term follow-up period. The incidence of adverse events did not rise with the increasing number of BoNT-A injections. A higher pre-treatment ICSI and ICPI score was predictive for successful response to repeated intravesical BoNT-A injections plus hydrodistention.

Highlights

  • Urinary frequency, urgency, and sterile urine resemble the characteristics of interstitial cystitis/bladder pain syndrome (IC/BPS)

  • We found there is a positive correlation between pre-treatment ICSI and ICPI scores with a successful outcome following repeated intravesical BoNT-A injections (Table 3)

  • We observed a significant improvement in both subjective symptoms and functional parameters in refractory IC/BPS after repeated intravesical injections of BoNT-A plus hydrodistention

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Summary

Introduction

Urinary frequency, urgency, and sterile urine resemble the characteristics of interstitial cystitis/bladder pain syndrome (IC/BPS). It is a chronic and debilitating urologic condition that affects millions of people worldwide. A variety of treatment modalities have been proposed, but very few or none have been successful in eradicating bladder pain and increasing bladder capacity [2]. Oral medications such as amitriptyline, cyclosporine A, or pentosan polysulphate have not been shown to provide long-term efficacy [1]. Intravesical instillation of hyaluronic acid is believed to protect leaky urothelium from irritants; a high symptom recurrence rate was reported [3]

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