PMID- 23511677
OWN - NLM
STAT- MEDLINE
DCOM- 20130906
LR  - 20220318
IS  - 2150-1149 (Electronic)
IS  - 1533-3159 (Linking)
VI  - 16
IP  - 2
DP  - 2013 Mar-Apr
TI  - Intravesical botulinum toxin a injections do not benefit patients with ulcer type 
      interstitial cystitis.
PG  - 109-16
AB  - BACKGROUND: Ulcer type and non-ulcer type interstitial cystitis/bladder pain 
      syndromes (IC/BPS) are considered different disease entities. Thus, intravesical 
      botulinum toxin A (BoNT-A) treatment outcomes could differ for each entity. 
      OBJECTIVES: To evaluate and compare the treatment outcomes of BoNT-A injections 
      for treatment of each IC/BPS type. STUDY DESIGN: Prospective interventional 
      study. SETTING: Tertiary medical center affiliated with Buddhist Tzu Chi General 
      Hospital and Tzu Chi University, Taiwan. METHODS: Forty-four consecutive patients 
      with IC/BPS for whom conventional treatments failed were prospectively enrolled 
      in this study. Patients were classified as having ulcer (n = 10) or non-ulcer (n 
      = 30) IC/BPS based on their previous cystoscopic findings. INTERVENTION: All 
      patients received 4 sets of intravesical BoNT-A injections (100 U in 40 
      suburothelial injections) every 6 months. The primary end-point was the global 
      response assessment (GRA) 6 months after the fourth set of BoNT-A injections. 
      Secondary end-points included the O'Leary-Sant score (OSS) including symptom 
      indexes (ICSI) and problem indexes (ICPI), visual analog scale (VAS) pain score, 
      voiding diary, and urodynamics variables. RESULTS: After 4 sets of BoNT-A 
      injections, 15 patients with non-ulcer IC/BPS had GRA scores >= 2, while the 
      other 15 had GRA scores < 2. All 10 patients with ulcer IC/BPS had GRA scores < 2 
      at the study end-point (treatment failure). At baseline, patients with ulcer 
      IC/BPS had significantly higher daytime frequency, nocturia, smaller functional 
      bladder capacity, smaller voided volume, greater VAS, smaller maximal bladder 
      capacity, and greater glomerulation grade than did patients with non-ulcer 
      IC/BPS. After 4 sets of BoNT-A injections, patients with non-ulcer IC/BPS and GRA 
      scores >= 2 or < 2 all had significantly decreased ICSI, ICPI, OSS, VAS pain 
      scores, frequency episodes, and increased functional bladder capacity. However, 
      patients with ulcer IC/BPS showed no significant change in any clinical or 
      urodynamic variable. After failure of repeated BoNT-A injections, all 10 patients 
      with ulcer IC/BPS underwent transurethral electrocauterization of their ulcers, 
      which resulted in immediate pain relief. LIMITATIONS: Lack of a control arm in 
      this study. CONCLUSION: Repeated intravesical BoNT-A injections provided 
      effective treatment outcomes at the end-point in half of the patients with 
      non-ulcer IC/BPS, but did not benefit any patient with ulcer type IC/BPS. Ulcer 
      type IC/BPS should be treated as a different disease than non-ulcer IC/BPS. 
      INSTITUTIONAL REVIEW: This study was approved by the Institutional Review Board 
      of the Tzu-chi General Hospital (TCGH 100-06).
FAU - Lee, Cheng-Ling
AU  - Lee CL
AD  - Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 
      Hualin, Taiwan.
FAU - Kuo, Hann-Chorng
AU  - Kuo HC
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Pain Physician
JT  - Pain physician
JID - 100954394
RN  - 0 (Neuromuscular Agents)
RN  - EC 3.4.24.69 (Botulinum Toxins, Type A)
SB  - IM
MH  - Administration, Intravesical
MH  - Adult
MH  - Aged
MH  - Botulinum Toxins, Type A/*administration & dosage
MH  - Cystitis, Interstitial/*drug therapy/pathology
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Neuromuscular Agents/*administration & dosage
MH  - Ulcer/*drug therapy/pathology
EDAT- 2013/03/21 06:00
MHDA- 2013/09/07 06:00
CRDT- 2013/03/21 06:00
PHST- 2013/03/21 06:00 [entrez]
PHST- 2013/03/21 06:00 [pubmed]
PHST- 2013/09/07 06:00 [medline]
PST - ppublish
SO  - Pain Physician. 2013 Mar-Apr;16(2):109-16.