Open Access

ARTICLE

Injection location does not impact botulinum toxin Aeffcacy in interstitial cystitis/bladder pain syndrome patients

Robert J. Evans¹, Tyler Overholt¹, Marc Colaco¹, Stephen J. Walker^1,2

1 Department of Urology/Female Pelvic Health, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
2 Wake Forest Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
Address correspondence to Dr. Stephen J. Walker, Wake Forest Institute for Regenerative Medicine, 391 Technology Way, Winston Salem, NC 27101 USA

Canadian Journal of Urology 2020, 27(1), 10125-10129.

Abstract

Introduction: Botulinum toxin A (BTX-A) is currently used as a fourth-line therapeutic option for interstitial cystitis/bladder pain syndrome (IC/BPS) management. The purpose of this study was to determine if BTX-A injection can mitigate pain and if injection location (i.e., trigone-including versus trigone-sparing injection template) impacts treatment efficacy and/or treatment complications profile.
Materials and methods: Female IC/BPS patients refractory to conservative management strategies were prospectively enrolled and asked to complete a baseline history and physical exam, post-void residual (PVR) urine volume determination, O’Leary Sant (OLS) questionnaire, and Pelvic Pain and Urgency/Frequency Symptom Scale (PUF) questionnaire. Participants were randomly assigned to one of two treatment groups and received either: 1) a trigone-including BTX-A injection template or 2) a trigone-sparing injection template. Following therapy, patients were examined in clinic at 30 and 90 days post-treatment with symptom re-assessment via repeat questionnaires and for evidence of post-procedural complications.
Results: Compared to baseline, patients in both treatment groups experienced significant improvement in OLS and PUF scores at both 30 and 90 days post-treatment with BTX-A, regardless of which injection template was used (p < 0.05). Complications resulting from BTX-A were minimal (most commonly urinary tract infection (UTI) and urinary retention) and not significantly different between the treatment groups (p > 0.05). No distant spread of BTX-A was observed in any patient in either treatment group.
Conclusions: BTX-A treatment using either a trigone-sparing or trigone-including injection template resulted in significant, but not location-dependent, improvement in IC/BPS symptom scores at 30 and 90 day points post-procedure with no significant difference in post-treatment complication profiles.

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