Predictive Factors for a Satisfactory Treatment Outcome with Intravesical Botulinum Toxin A Injection in Patients with Interstitial Cystitis/Bladder Pain Syndrome.

Hsiu-Jen Wang,Hueih-Ling Ong,Hann-Chorng Kuo,Wan-Ru Yu

doi:10.3390/toxins11110676

Hsiu-Jen Wang, Hueih-Ling Ong + Show 2 more

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https://doi.org/10.3390/toxins11110676

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Journal: Toxins	Publication Date: Nov 19, 2019
Citations: 10	License type: CC BY 4.0

Affiliation: Tzu Chi University

Abstract

A botulinum toxin A (BoNT-A) intravesical injection can improve the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Patients with IC/BPS have different clinical characteristics, urodynamic features, and cystoscopic findings. This study assessed the treatment outcomes of a BoNT-A intravesical injection and aimed to identify the predictive factors of a satisfactory outcome. This retrospective study included IC/BPS patients treated with 100 U BoNT-A. The treatment outcomes were assessed by global response assessment (GRA) at 6 months. We classified patients according to different clinical, urodynamic, and cystoscopic characteristics and evaluated the treatment outcomes and predictive factors. A total of 238 patients were included. Among these patients, 113 (47.5%) had a satisfactory outcome (GRA ≥ 2) and 125 (52.5%) had an unsatisfactory outcome. Improvements in the IC symptom score, IC problem score, O’Leary–Sant symptom score, and visual analog scale score for pain were significantly greater in patients with a satisfactory outcome than in patients with an unsatisfactory outcome (all p = 0.000). The IC disease duration and maximal bladder capacity (MBC) were significantly different between patients with and without a satisfactory outcome. Multivariate analysis revealed that only the MBC was a predictor for a satisfactory outcome. Patients with a MBC of ≥760 mL and glomerulations of 0/1 (58.7%) or glomerulations of 2/3 (75.0%) frequently had a satisfactory outcome. We found that BoNT-A intravesical injection can effectively improve symptoms among patients with IC/BPS, with a remarkable reduction in bladder pain. A MBC of ≥760 mL is a predictive factor for a satisfactory treatment outcome.

Highlights

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a clinical symptom syndrome characterized by frequency, urgency, and nocturia, with or without bladder pain [1]
According to the treatment outcome, the result revealed that a maximal bladder capacity (MBC) of ≥760 Maximal bladder capacity (mL) had the greatest area under the curve (AUC = 0.547)
Patients with glomerulation grade 2/3 and MBC ≥ 760 mL had a satisfactory rate of 75%, and those with glomerulation grade 0/1 and MBC ≥ 760 mL had a satisfactory rate of 58.7%, the satisfactory rates of the other subgroups were approximately 40% (p = 0.024) (Table 2)

Summary

Introduction

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a clinical symptom syndrome characterized by frequency, urgency, and nocturia, with or without bladder pain [1]. This mysterious disease has been documented for over 100 years, the underlying pathophysiology is still not well elucidated. Chronic inflammation of the bladder has been accepted as the fundamental cause of IC/BPS [5]; the reasons for inflammation are unclear. A previous study demonstrated that intravesical botulinum toxin A (BoNT-A) can reduce bladder pain in IC/BPS patients [12]. Repeated BoNT-A intravesical injections have been shown to increase functional bladder capacity and reduce bladder pain in responders [13]

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Conclusion