title: Hydrodistension plus Onabotulinumtoxin A in bladder pain syndrome refractory to conservative treatments.
abstract: BACKGROUND
  For bladder pain syndrome (BPS) refractory to conservative treatment, the European guidelines consider bladder hydrodistention (HD) under anaesthesia and the injection of Onabotulinumtoxin A (OnabotA) jointly. The objective of this study was to assess our experience in implementing this technique.
  
  
  METHODS
  A prospective study of 25 patients with BPS who underwent HD plus a submucosal injection of 100 U of OnabotA in trigone. The Hunner lesions were treated endoscopically using resection or electrocoagulation. Thirty-eight procedures were performed (25 first interventions and 13 reoperations). To study the clinical change, we evaluated the subjective improvement (Treatment Benefit Scale [TBS] and Patient Global Impression of Change [PGIC] scales), the visual analogue scale (VAS) for pain, the Bladder Pain/Interstitial Cystitis Symptom Score (BPIC-SS) questionnaire and the voiding diary for 3 days. For the data analysis, we employed the Wilcoxon, Kruskal-Wallis, Kaplan-Meier and log-rank tests.
  
  
  RESULTS
  We observed subjective improvement in 21 patients (84%), which was significant in 47% of these patients, moderate in 41.2% and slight in 11.8%. Four patients did not improve. A post-treatment reduction in the pain VAS (from 7.1 to 1.8 points; P=.001), in daytime (from 11.8 to 7.5; P=.012) and night-time (from 5.9 to 3.6; P=.003) voiding frequency and in the BPIC-SS (from 27.9 to 11.2 points; P=.042). The degree of improvement was not related to age, the presence of bladder lesions or the treatment of relapses. The median duration of improvement was 7 months (95% CI 5.69-8.31), although this duration was somewhat longer for the patients younger than 65 years. Mild complications occurred in 23.7% of the cases.
  
  
  CONCLUSIONS
  The joint implementation of HD plus OnabotA is a valid therapeutic option in refractory BPS, which provides good clinical results and maintains its effectiveness in retreatments.
authors.affiliation: Servicio Urología, Hospital Universitari i Politècnic La Fe, Valencia, España. Electronic address: laurals_8@hotmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Lorenzo
authors.affiliation: Servicio Urología, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Bonillo
authors.affiliation: Servicio Urología, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors.forename: S
authors.initials: S
authors.lastname: Arlandis
authors.affiliation: Servicio Urología, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors.forename: E
authors.initials: E
authors.lastname: Martínez-Cuenca
authors.affiliation: Servicio Urología, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors.forename: L
authors.initials: L
authors.lastname: Marzullo
authors.affiliation: Servicio Urología, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors.forename: E
authors.initials: E
authors.lastname: Broseta
authors.affiliation: Servicio Urología, Hospital Universitari i Politècnic La Fe, Valencia, España.
authors.forename: F
authors.initials: F
authors.lastname: Boronat
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D000283:Administration, Intravesical; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D000072700:Conservative Treatment; D018856:Cystitis, Interstitial / Q000188:drug therapy / Q000628:therapy*; D004106:Dilatation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014867:Water / Q000008:administration & dosage*
chemical_list: D065087:Acetylcholine Release Inhibitors; D014867:Water; D019274:Botulinum Toxins, Type A
keywords: Bladder pain syndrome; Cistitis intersticial; Hidrodistensión; Hunner's lesion; Hydrodistention; Interstitial cystitis; Lesión de Hunner; Onabotulinumtoxin A; Síndrome de dolor vesical