Abstract
Treatment for patients with interstitial cystitis/bladder pain syndrome (IC/BPS) is always challenging for urologists. The main mechanism of the botulinum toxin A (BoNT-A) is inhibition of muscle contraction, but the indirect sensory modulation and anti-inflammatory effect in the bladder also play important roles in treating patients with IC/BPS. Although current guidelines consider BoNT-A injection to be a standard treatment, some practical issues remain debatable. Most clinical evidence of this treatment comes from retrospective uncontrolled studies, and only two randomized placebo-control studies with limited patient numbers have been published. Although 100 U BoNT-A is effective for most patients with IC/BPS, the potential efficacy of 200 U BoNT-A has not been evaluated. Both trigone and diffuse body BoNT-A injections are effective and safe for IC/BPS, although comparison studies are lacking. For IC/BPS patients with Hunner’s lesion, the efficacy of BoNT-A injection remains controversial. Most patients with IC/BPS experience symptomatic relapse at six to nine months after a BoNT-A injection, although repeated injections exhibit a persistent therapeutic effect in long-term follow-up. Further randomized placebo-controlled studies with a larger number of patients are needed to support BoNT-A as standard treatment for patients with IC/BPS.
Highlights
Since the early 19th century, patients who exhibited chronic bladder pain, urinary frequency, and urgency without evidence of urinary tract infection or bladder stones have been diagnosed with interstitial cystitis (IC) [1]
Key Contribution: This review summarized the mechanisms of using botulinum toxin for interstitial cystitis, and presented several clinical debatable practical issues which should be noticed by clinicians
The C-terminal of the heavy chain binds to the synaptic vesicle protein 2 on the neuronal cell membrane, enabling botulinum toxin A (BoNT-A) to be internalized within the nerve terminal by endocytosis [14]
Summary
Since the early 19th century, patients who exhibited chronic bladder pain, urinary frequency, and urgency without evidence of urinary tract infection or bladder stones have been diagnosed with interstitial cystitis (IC) [1]. As our understanding of IC has progressed over the past 200 years, its name and definition have changed many times.[1] Because patients with IC may not experience bladder inflammation, the term “interstitial cystitis/bladder pain syndrome” (IC/BPS) is considered to be more suitable and is widely used in current guidelines [2,3]. The prevalence has shown an increasing trend in recent years [4], the treatment of patients with IC/BPS remains challenging for urologists. BoNT-A is widely used to treat various types of complicated LUTDs, and many clinical trials have proven its efficacy [9]. The treatment of IC/BPS has shown great progress with the use of the intravesical BoNT-A injection, and laboratory studies have demonstrated bladder improvement after BoNT-A injection [10]. This review summarizes the possible pathomechanisms of using BoNT-A for treatment of IC/BPS in the bladder and examines the practical issues and long-term efficacy of such treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
