title: Intravesical onabotulinumtoxinA injections for refractory painful bladder syndrome.
abstract: BACKGROUND
  Bladder pain associated with interstitial cystitis and painful bladder syndrome (IC/PBS) is frequently excruciating and intractable. The use of onabotulinumtoxinA (BoNT-A) for relief of this type of bladder pain has not been well described.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of intravesical BoNT-A injection for treatment of IC/PBS refractory to conventional treatment.
  
  
  METHODS
  Prospective, non-randomized study.
  
  
  METHODS
  A tertiary medical center in Taiwan.
  
  
  METHODS
  Sixty-seven patients with characteristic IC/PBS were enrolled. Intravesical injection of 100U of BoNT-A immediately followed by cystoscopic hydrodistention under intravenous general anesthesia. Changes of the urodynamic parameters, O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), visual analog score (VAS) for pain, functional bladder capacity, and global response assessment (GRA) were evaluated at baseline and 6 months after BoNT-A injection. Adverse events that occurred after this procedure were also assessed.
  
  
  RESULTS
  Significant improvement was shown after intravesical injection of 100 U of BoNT-A. Baseline and 6 months after injection scores were: ICSI and ICPI (23.6 ± 5.9 versus 15.2 ± 8.5, P = 0.000), VAS (5.3 ± 2.2 versus 3.3 ± 2.4, P = 0.000), functional bladder capacity (136 ± 77.6 versus 180 ± 78.2, P = 0.000) and GRA (0.3 ± 0.8 versus 1.4 ± 1.0, P = 0.000).
  
  
  CONCLUSIONS
  This study lacks a placebo control group so the placebo effect cannot be eliminated. This study also does not provide information about the efficacy of this treatment after 6 months.
  
  
  CONCLUSIONS
  Intravesical onabotulinumtoxinA injection appears to be a safe and effective therapeutic option for analgesia and increased bladder capacity for patients with IC/PBS. INSTITUTIONAL REVIEW: This study was approved by the Institutional Review Board of the Buddhist Tzu-chi General Hospital.
authors.affiliation: Department of Urology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Shiu-Dong
authors.initials: SD
authors.lastname: Chung
authors.forename: Yuh-Chen
authors.initials: YC
authors.lastname: Kuo
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000283:Administration, Intravesical; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D018856:Cystitis, Interstitial / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A