title: Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection.
abstract: Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months' duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital, and Tzu Chi University, Hualien 970, Taiwan. alur1984@hotmail.com.
authors.forename: Jia-Fong
authors.initials: JF
authors.lastname: Jhang
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital, and Tzu Chi University, Hualien 970, Taiwan. hck@tzuchi.com.tw.
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D006801:Humans; D059952:Pelvic Floor Disorders / Q000188:drug therapy; D013001:Somatoform Disorders / Q000188:drug therapy*; D013577:Syndrome; D014570:Urologic Diseases / Q000188:drug therapy*
chemical_list: D000700:Analgesics; D000893:Anti-Inflammatory Agents; D019274:Botulinum Toxins, Type A
keywords: chronic prostatitis; interstitial cystitis; pelvic floor