Preliminary results of suburothelial injection of botulinum a toxin in the treatment of chronic interstitial cystitis

PURPOSE: Treatment of interstitial cystitis is usually not successful in eradicating bladder pain and increased bladder capacity. This study was designed to evaluate the clinical effectiveness of suburothelial injection of botulinum A toxin in patients with chronic interstitial cystitis. METHODS: Eight women and 2 men with chronic interstitial cystitis who had failed conventional treatments were enrolled in this study. In 5 patients, 100 units of botulinum A toxin was injected suburothelially into 20 sites, and an additional 100 units was injected into the trigone in the other 5 patients. Therapeutic outcome including functional bladder capacity, number of daily urinations, bladder pain, and urodynamic changes were compared between baseline and 3 months after treatment. RESULTS: In 2 patients bladder pain and urinary frequency were improved 3 months after treatment. Mild difficulty in urination was reported by 7 patients. Functional bladder capacity recorded in a voiding diary was significantly increased (155+/-26.3 vs. 77+/-27.1 ml, p<0.001), and the frequency of daily urinations (18+/-7.7 vs. 24.2+/-10.3, p=0.025) and the pain score (2.4+/-1.6 vs. 3.2+/-1.1, p=0.003) were mildly but significantly reduced after treatment. Only the cystometric capacity improved significantly (287+/-115 vs. 210+/-63.8 ml, p=0.05) in urodynamic results. Trigonal injection had no therapeutic effect on symptom or urodynamic improvement. No adverse effect was reported. CONCLUSIONS: The clinical result of suburothelial botulinum A toxin injection was disappointing. None of the patients was symptom free and only a limited improvement in bladder capacity and pain score was achieved in 2 patients.     

Intravesical botulinum toxin A injections in the treatment of painful bladder syndrome/interstitial cystitis: a systematic review

Introduction and hypothesis  

Intravesical botulinum toxin A (BTX-A) is emerging as a potential new treatment for refractory interstitial cystitis (IC). However, there has been conflicting evidence on this treatment's effectiveness. The aim of our systematic review was to assess the effectiveness and adverse effects of intravesical BTX-A in IC.     

Intravesical instillation of botulinum toxin A: an in vivo murine study and pilot clinical trial

Aim  

The objectives of this study were to compare the urodynamic effects of botulinum toxin A (BoNT-A) delivered via intramural injection into the bladder wall to that of intravesical instillation in a rat model of detrusor overactivity and to evaluate the effects of intravesical instillation of BoNT-A in female patients with idiopathic overactive bladder.     

膀胱内灌注治疗在间质性膀胱炎中的应用

膀胱内灌注治疗已广泛应用于间质性膀胱炎的治疗,能用作膀胱内灌注的药物种类繁多,其作用机理、疗效及副反应表现不一,本文就目前常用的几类药物的应用情况作一综述.     

膀胱内灌注治疗在间质性膀胱炎中的应用

膀胱内灌注治疗已广泛应用于间质性膀胱炎的治疗,能用作膀胱内灌注的药物种类繁多,其作用机理、疗效及副反应表现不一,本文就目前常用的几类药物的应用情况作一综述.     

膀胱内灌注治疗在间质性膀胱炎中的应用

膀胱内灌注治疗已广泛应用于间质性膀胱炎的治疗,能用作膀胱内灌注的药物种类繁多,其作用机理、疗效及副反应表现不一,本文就目前常用的几类药物的应用情况作一综述.     

Intravesical infusion of resiniferatoxin by a temporary in situ drug delivery system to treat interstitial cystitis: a pilot study

PURPOSE: Interstitial cystitis (IC), a syndrome characterized by motor and sensory dysfunction of the lower urinary tract, represents a diagnostic and therapeutic challenge even to highly skilled physicians. We investigated the technical feasibility and the clinical efficacy of a prolonged intravesical instillation of RTX by in situ drug delivery system in patients with IC. MATERIAL AND METHODS: 5 female patients (mean age 48.7 years) received a prolonged infusion of a saline solution containing 10nM of resiniferatoxin at the flow rate 25microl/h by the MiniMed 407C Infusion Pump (MiniMed Sylmar, CA, USA), connected to sovrapubic 5Fr mono Pigtail catheter, for 10 days. All patients reported frequency, nocturia and urgency, and symptoms of pelvic pain for at least six months. They showed the absence of urinary tract infection within the last three months, the absence of functional disorders of lower urinary tract and no other vesical or urethral pathology. The pre-treatment (PT) frequency/volume (FV) chart and a pain score (VAS score) were recorded. Patients were evaluated after 30 days from the end of infusion (primary end point, PEP) and after three months (secondary end point, SEP). RESULTS: At PEP frequency reduced from 11.3+/-1.39 to 7.4+/-1.51 (p<0.01) and nocturia from 3.6+/-0.54 to 1.2+/-0.44 (p<0.01). A highly significant reduction of pain score was observed at PEP: it decreased to 2.4+/-0.54 from 6.7+/-0.83 (p<0.01). The pain score remained significantly lower at SEP (3.2+/-0.44 p<0.05). Nocturia was also statistically reduced at SEP (1.9+/-0.74) as well as frequency (8.7+/-1.76). No side effects were reported during the infusion as well as after the removal of the catheter. CONCLUSION: The present study demonstrates that the prolonged intravesical instillation of a drug by in situ drug delivery system is a feasible procedure and seems to support the efficacy of RTX in the treatment of IC patients. However further studies are necessary and mandatory to confirm our results and to define the exact action mechanism of prolonged infusion of RTX, the dosage and the treatment schedule.     

Treatment of overactive bladder with botulinum toxin type B: a pilot study

The purpose of this study was to determine the efficacy and safety of botulinum toxin type B (BTX-B/Myobloc) in the treatment of patients with overactive bladder. This open-label dose-escalation study enrolled 15 female patients with urinary frequency with or without incontinence. The BTX-B doses used in this study were 2500, 3750, 5000, 10 000 and 15 000 units. Response was defined as a subjective improvement in frequency, urgency and incontinence symptoms. A paired t-test of the pre/post frequency difference indicates that these 15 patients experienced an average of 5.27 fewer frequency episodes per day after treatment with BTX-B. The p value for the paired t-test was <0.001. The longest duration effect was 3 months using 10 000–15 000 units of BTX-B. The correlation between dose and duration was very significant, with a correlation coefficient = 0.96, p<0.001. Based on these findings, we feel the use of botulinum toxin to treat patients with overactive bladder warrants further study.Abbreviations OAB Overactive bladder Editorial Comment: The authors discuss the short-term efficacy of botulinum toxin type B in patients with overactive bladder. An attempt is made to identify the highest safe dosage, but the data presented are limited and a final recommendation regarding this requires further study. The high correlation found between dosage and duration of efficacy is very interesting and clinically relevant. Such a relationship has not been previously described for botulinum toxin type A. The duration of response is concerning and does appear to be significantly lower than that previously published and what I have personally experienced with botulinum toxin type A. Although this may be due to variations in injection technique, it may also be a result of the type of toxin used. I agree that longer-term and comparative data are warranted.     

Intravesical lidocaine in severe interstitial cystitis. Case report

We report on a patient with a 2-year history of severe interstitial cystitis with disabling symptoms of painful urgency and urinary incontinence. The condition is characterized by a severe inflammatory reaction in the cystic wall and varying degrees of success for most therapeutic measures employed. Repeated vesical instillations of lidocaine in the urinary bladder relieved the patient from her pain and induced a long-lasting and potent anti-inflammatory effect on the cystic wall. Plasma lidocaine concentrations were below toxic levels and no adverse reactions were reported.     

Hyperbaric oxygen for the treatment of interstitial cystitis: long-term results of a prospective pilot study

OBJECTIVE: We conducted a prospective pilot study to assess the safety and efficacy of hyperbaric oxygen (HBO) for the treatment of interstitial cystitis (IC). METHODS: Six patients underwent 30 sessions of 100% oxygen inhalation in a hyperbaric chamber and were followed up over 15 months. The measures of efficacy were changes in pain and urgency (visual analog scales), alteration in the patient's assessment of overall change in his well-being (Patient Global Assessment Form), and changes in frequency and functional bladder capacity (48-hours voiding log). Evaluation of symptom severity regarding pain and voiding problems was done using the O'Leary-Sant index. RESULTS: Four patients rated the therapeutic result as either excellent or good and assessed their well-being after HBO treatment as improved. Two patients showed only short-term amelioration of some of their symptoms. At 12 months follow-up the baseline functional bladder capacity increased from 37-161 ml (range) to 160-200 ml in the responder group. The 24-hour voiding frequency decreased from 15-27 to 6-11 voids per day, a pain scale improvement from 20-97 mm at baseline to 3-30 mm at 12 months follow-up and an urgency scale improvement from 53-92 mm to 3-40 mm, respectively was observed at 12 month follow-up. The symptom and pain index score decreased from 23-35 at baseline to 3-17 at 12 months follow-up. CONCLUSION: HBO appears to be effective to treat IC patients. Treatment was well tolerated and resulted in a sustained decrease of pelvic pain and urgency, improvement of voiding patterns and increase of functional bladder capacity for at least 12 months.     

肝素膀胱灌注治疗间质性膀胱炎

目的　观察肝素膀胱灌注治疗间质性膀胱炎的疗效。　方法　 17例间质性膀胱炎患者 ,均为女性。平均年龄 35岁。平均病程 2 7个月。临床表现主要为尿频及膀胱区疼痛。膀胱镜检见黏膜下点状出血 15例 ,Hunner溃疡 2例。按O’Leary Sant间质性膀胱炎症状评分 (ICSI) 8～ 18分 ,平均 (13.4± 3.5 )分 ;问题评分 (ICPI) 3～ 12分 ,平均 (8.2± 3.4 )分。所有患者均使用肝素钠 10 5U膀胱灌注 ,每周 3次 ,疗程 4周。观察治疗后患者症状改善情况。　结果　 17例患者随访 3～ 12个月 ,平均 6个月 ,症状缓解 14例 ,其中症状显著缓解或消失 9例 ,评分下降 7分 ;症状部分缓解 5例 ,评分下降 >3分 ;无效 3例。 2例于治疗 7个月及 9个月症状复发。有效率 82 %。治疗后 1、2个月ICSI分别降至 (6 .1± 3.4 )、(6 .3± 3.5 )分 ,ICPI分别降至 (3.5± 2 .9)、(3.6± 2 .7)分 ,治疗前后比较差异有显著性意义 (P <0 .0 1)。治疗期间发生一过性尿道灼痛者 2例 ,轻微肉眼血尿 1例。　结论　肝素膀胱灌注治疗可有效缓解间质性膀胱炎患者症状 ,提高生活质量。