title: Persistent therapeutic effect of repeated injections of onabotulinum toxin a in refractory bladder pain syndrome/interstitial cystitis.
abstract: OBJECTIVE
  We evaluate the efficacy and safety of repeated intratrigonal injections of onabotulinum toxin A in patients with bladder pain syndrome/interstitial cystitis.
  
  
  METHODS
  This is a single center, long-term, prospective study in which 16 women with bladder pain syndrome/interstitial cystitis refractory to standard treatment received 4 consecutive intratrigonal injections of onabotulinum toxin A. Onabotulinum toxin A (100 U) was injected under cystoscopic control in 10 trigonal sites, each receiving 10 U in 1 ml saline. General anesthesia was used in all treatments. Re-treatment was allowed 3 months after injection. Outcome measures included pain visual analog scale (0-10), O'Leary-Sant score, a 3-day voiding chart and a quality of life questionnaire at the first month and every 3 months after each injection. Voiding dysfunction and urinary tract infections were assessed at 2 weeks and every 3 months afterward. Treatment duration was determined when patients requested another injection.
  
  
  RESULTS
  Mean ± SD patient age was 41.8 ± 12.5 years. At baseline pain score was 5.9 ± 1.8, O'Leary-Sant score 28.8 ± 6.3, urinary frequency 16.4 ± 5.3, mean voided volume 112 ± 42 ml and quality of life 5 ± 0.9. Mean decrease in pain score, O'Leary-Sant score, urinary frequency and mean increase in voided volume and quality of life were similar after each treatment. Individual symptom relief lasted 6 to 12 months with an average duration of 9.9 ± 2.4 months. There were no cases of voiding dysfunction. Five patients had noncomplicated urinary tract infections.
  
  
  CONCLUSIONS
  Symptomatic improvement of bladder pain syndrome/interstitial cystitis persists in a repeated intratrigonal injection program of 100 U onabotulinum toxin A. Time to request re-treatment remained stable. Adverse events were mild, without voiding dysfunction requiring intermittent catheterization.
authors.affiliation: Department of Urology, Hospital de São João, Porto, Portugal. ruipinto@mac.com
authors.forename: Rui
authors.initials: R
authors.lastname: Pinto
authors.forename: Tiago
authors.initials: T
authors.lastname: Lopes
authors.forename: João
authors.initials: J
authors.lastname: Silva
authors.forename: Carlos
authors.initials: C
authors.lastname: Silva
authors.forename: Paulo
authors.initials: P
authors.lastname: Dinis
authors.forename: Francisco
authors.initials: F
authors.lastname: Cruz
mesh_terms: D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D018856:Cystitis, Interstitial / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D019274:Botulinum Toxins, Type A