The efficacy and safety of intradetrusor injection of botulinum toxin type A in treatment of ketamine-related cystitis

Abstract

Objective To evaluate the efficacy and safety of intradetrusor injection of botulinum toxin type A in the treatment of ketamine-related cystitis. Methods A retrospective analysis of clinical data of 36 ketamine-related cystitis patients with intradetrusor injection of botulinum toxin type A treatment in our hospital during August 2010 to December 2015 was conducted, including 31 males and 5 females with a mean age of 25.5 years. All patients had failed to conventional treatment options including cessation of ketamine, antibiotics, M-blockers. At the time of the first injection, patients were injected with 200 U botulinum toxin type A diluted in 15 ml of 0.9% saline into the detrusor muscle at 30 sites, sparing the trigone, under cystoscopic guidance. 3-d voiding diary, interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), pelvic pain and urinary frequency/urgency symptom score (PUF) were recorded to evaluate the efficacy. The treatment-related complications were recorded. When the efficacy of botulinum toxin type A decreased and the patient's symptoms returned to baseline before treatment, the patient received repeated injections of botulinum toxin type A with the same dose and method as the first injection. Results Thirty-six patients with ketamine-related cystitis were treated with intradetrusor injection of botulinum toxin type A. Sixteen patients received two injection treatments and two patients received three injection treatments. During the follow-up, 3-d urinary diaries, ICSI, ICPI, and PUF showed a significant improvement in outcome at 4 weeks after the first injection. The efficacy of the second and third injection treatment was also remarkable. Three patients developed urinary tract infection after the first injection, and two patients developed urinary tract infection after the second injection. Mild hematuria occurred in 15 patients after the first injection, and mild hematuria occurred in 7 patients after the second injection, which was improved in 1 to 2 days. All patients did not appear acute urinary retention and other adverse drug reactions. Conclusions Intradetrusor injection of botulinum toxin type A could be a safe and effective method for the treatment of ketamine-related cystitis.Repeated injection therapy is still safe and effective. Key words: Cystitis; Ketamine; Botulinum toxin type A; Repeated injection