1677 INTRA-TRIGONAL INJECTION OF BOTULINUM TOXIN A IN PATIENTS WITH REFRACTORY BLADDER PAIN SYNDROME DECREASES URINARY NEUROTROPHINS AND IMPROVES LOWER URINARY TRACT SYMPTOMS

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

This study evaluates the efficacy and tolerability of repeated intra-trigonal injection of BoNT-A in patients with BPS/IC refractory to first line treatment. It also accesses urinary levels of Neurotrophins, nerve growth factor (NGF) and brain derived growth factor (BDNF) before and after treatment.

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METHODS 

Twenty-six women (mean age 48 years) with BPS/IC (ESSIC classification: 2a, 1; 2b, 1; 2c, 6; 3a, 1; 3b, 2; 3c, 15) had a 3-day voiding chart, O'Leary-Sant Score (OSS), QoL from IPSS, pain visual analogue scale (0-10) and cystometry before treatment and at 1, 3, 6, 9, 12, 15 and 18 months follow-up. Urinary levels of NGF and BDNF were assessed in 10 patients (type 3c, ESSIC) at baseline, 1, 3 and 6 months after injection (normalized by urinary creatinine concentration). All patients received 100 U of Botox™ in 10 trigonal sites and were discharged with prophylactic antibiotic.

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RESULTS 

All patients reported subjective improvement at 1 and 3 month follow up. Pain score decreased from 5.7±2.0 to 2.2±0.4 and 1.9±0.9 at 1 and 3 months, respectively (p<0.05). Frequency decreased from 17±6.3 to 8.9±2.4 and 10±2.4, respectively (p<0.05). OSS for symptoms decreased from 15.3±3.2 to 9±0.8 and 6.2±1.3 while OSS for problems decreased from 12.8±3.4 to 4.3±2.4 and to 4.3±1.4, respectively (p<0.05). QoL also decreased from 5.1±1.0 to 1.8±0.4 and 0.9±0.3 (p<0.05). Bladder volume for the first pain sensation increased from 38±19 ml at baseline to 109±22 and 110±23 ml at 1 and 3 months, respectively (p<0,01). Maximum cystometric capacity also increased from 89±35 ml to 268±54 and 326±79 ml at the same time points (p<0,01). A request for re-treatment was made by 3/26 patients that reached the 6 month visit, 4/13 that reached the 9 month visit and 9/9 patients that reached the 12 month visit. Data from retreatment are available at 3 and 6 months follow-up for 16 patients. Pain score, Frequency, OSS, QoL and urodynamic findings followed a similar pattern to previous one after first treatment (p<0.05). NGF changed from 16.8±19.9 at baseline to 4.7±1.7, 8.1±2.4 and 14.4±7.6 after 1, 3 and 6 months (p<0.05 at month 1 and 3). BDNF changed from 29.7±19.5 to 12.3±6.8, 22.4±5.5 and 24.9±10.0 at same time points (p<0.05 at month 1). No cases of voiding dysfunction occurred.

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CONCLUSIONS 

Intra-trigonal injection of 100 U of BoNT-A is a safe, effective and reproducible treatment for refractory BPS/IC. BoNT-A promotes a transient decrease in urinary levels of NGF and BDNF, which might indicate a decreased stimulation of nociceptive bladder afferents.