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MP29-18: Botulinum Toxin A bladder injection in the treatment of Bladder Pain Syndrome/IC: Trying to standardize the technique

Saturday, May 13
9:30 AM - 11:30 AM
Location: BCEC: Room 151

Presentation Authors: Cristina Gutiérrez*, Carlos Errando, Nicolas Nervo, Pedro Araño, Humberto Villavicencio, Barcelona, Spain

Introduction: Bladder Pain Syndrome/Interstitial cystitis (BPS) is a very complex entity with no clear etiology. Intravesical Botulinum Toxin is accepted as a 4th line treatment in BPS. The injection procedure is not standardized yet.

The aim of the present study is to evaluate the efficacy of Botulinum Toxin A (BoNT A) intravesical injections in patients with BPS after a standarized injection procedure.
Secondarily, we evaluate the complications, duration of response, and the effect of adding hydrodistension (HD) during the procedure.


Methods: Fourty one patients with BPS treated between January 2008 to march 2015 were retrospectively evaluated. All patients received 200 UI of BoNT A injected under cystoscopic control: 100 UI in the trigone plus 100 UI in the detrusor. In 26 patients HD was also performed. Three days voiding chart, Visual Analogue Scale (VAS) for pain, Global Response Assessment (GRA) and urodynamic parameters were evaluated at baseline and after treatment.

Results: After a mean follow-up of 36 months, 25 patients (61%) reported subjective improvement (-3 points in VAS) lasting during 7 months as an average (range 3-18). Eight patients (20%) reported total relief of pain (VAS = 0). Daytime and nighttime urinary frequencies were reduced, reaching statistically significance only at night (from 7 to 4 times p < 0.001). Functional bladder capacity measured by voiding chart increased significantly (from 73 to 115 ml p < 0.003). Mean voided volume at uroflowmetry increased significantly (from 100 to 191 ml p < 0.001). Four patients reported incomplete bladder emptying, however there were no significant increase in postvoid residual volume. The comparison between HD and nonHD groups of patients did not show a significant difference in objective parameters. However, the HD group showed a significantly better GRA (7 versus 4 p <0.02).

Conclusions: The proposed procedure of BoNT A injection (100UI trigone + 100 UI detrusor plus HDT) was effective and safe in treating refractory BPS in our study improving significantly the nighttime frequency, voided volume in voiding chart and uroflowmetry, and relieving totally the pain in 20% of cases. HD provides a better subjective response without increasing morbidity.


Source Of Funding: None

Cristina Gutiérrez

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MP29-18: Botulinum Toxin A bladder injection in the treatment of Bladder Pain Syndrome/IC: Trying to standardize the technique



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