Using Botulinum Toxin A for Treatment of Interstitial Cystitis/Bladder Pain Syndrome-Possible Pathomechanisms and Practical Issues.

Publisher: MDPI Country of Publication: Switzerland NLM ID: 101530765 Publication Model: Electronic Cited Medium: Internet ISSN: 2072-6651 (Electronic) Linking ISSN: 20726651 NLM ISO Abbreviation: Toxins (Basel) Subsets: MEDLINE

Original Publication: Basel : MDPI

Anti-Inflammatory Agents/*therapeutic use ; Botulinum Toxins, Type A/*therapeutic use ; Cystitis, Interstitial/*drug therapy ; Pain/*drug therapy ; Urinary Bladder/*drug effects; Administration, Intravesical ; Anti-Inflammatory Agents/administration & dosage ; Anti-Inflammatory Agents/adverse effects ; Botulinum Toxins, Type A/administration & dosage ; Botulinum Toxins, Type A/adverse effects ; Cystitis, Interstitial/complications ; Humans ; Pain/complications ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Urothelium/drug effects

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.

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Keywords: Botulinum toxin; inflammation; interstitial cystitis; treatment

0 (Anti-Inflammatory Agents)
EC 3.4.24.69 (Botulinum Toxins, Type A)

Date Created: 20191107 Date Completed: 20201021 Latest Revision: 20201021

20250114

PMC6891305

10.3390/toxins11110641

31689912