Intravesical Botulinum Toxin A Injections for Bladder Pain Syndrome/Interstitial Cystitis: A Systematic Review and Meta-Analysis of Controlled Studies.
BACKGROUND The role of intravesical botulinum toxin A (BTX-A) injections in bladder pain syndrome/interstitial cystitis (BPS/IC) has not been clearly defined. The aim of this study was to evaluate high-level evidence regarding the efficacy and safety of BTX-A injections for BPS/IC. MATERIAL AND METHODS We conducted a comprehensive search of PubMed, Embase, and Web of Science, and conducted a systematic review and meta-analysis of all available randomized controlled trials (RCTs) and controlled studies assessing BTX-A injections for BPS/IC. RESULTS Seven RCTs and 1 retrospective study were identified based on the selection criteria. Pooled analyses showed that although BTX-A was associated with a slightly larger volume of post-void residual urine (PVR) (weighted mean difference [WMD] 10.94 mL; 95% confidence intervals [CI] 3.32 to 18.56; p=0.005), patients in this group might benefit from greater reduction in pelvic pain (WMD -1.73; 95% CI -3.16 to -0.29; p=0.02), Interstitial Cystitis Problem Index (ICPI) scores (WMD -1.25; 95% CI -2.20 to -0.30; p=0.01), and Interstitial Cystitis Symptom Index (ICSI) scores (WMD -1.16; 95% CI -2.22 to -0.11; p=0.03), and significant improvement in daytime frequency of urination (WMD -2.36; 95% CI -4.23 to -0.49; p=0.01) and maximum cystometric capacity (MCC) (WMD 50.49 mL; 95% CI 25.27 to 75.71; p<0.00001). Nocturia, maximal urinary flow rate, dysuria, and urinary tract infection did not differ significantly between the 2 groups. CONCLUSIONS Intravesical BTX-A injections might offer significant improvement in bladder pain symptoms, daytime urination frequency, and MCC for patients with refractory BPS/IC, with a slightly larger PVR. Further well-designed, large-scale RCTs are required to confirm the findings of this analysis.
Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).
Junpeng
J
Wang
Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).
Qiang
Q
Wang
Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).
Qinghui
Q
Wu
Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).
Yang
Y
Chen
Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).
Peng
P
Wu
D000283:Administration, Intravesical; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D018856:Cystitis, Interstitial / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D053159:Dysuria / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D010147:Pain Measurement; D017699:Pelvic Pain / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D017594:Publication Bias; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014554:Urination
D019274:Botulinum Toxins, Type A