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Yu J, Lee CU, Lee KS, Ko KJ. Optimal endoscopic treatment and partial cystectomy with or without bladder augmentation for Hunner-type interstitial cystitis. Low Urin Tract Symptoms 2023; 15:216-224. [PMID: 37750459 DOI: 10.1111/luts.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) presents a significant challenge for urologists in terms of management, owing to its chronic nature and adverse impact on patient quality of life. Given the potential distinction between two disease entities within IC/BPS, namely Hunner-type IC and BPS without Hunner lesion, there is a need for an optimal therapeutic approach that focuses on the bladder lesions in Hunner-type IC. In cases where Hunner lesions are observed, complete transurethral ablation of these lesions should be prioritized as the initial intervention, as it has demonstrated effectiveness in symptom control. However, recurrence remains a limitation of this intervention. The techniques of resection and coagulation are equally effective in terms of symptom relief and recurrence prevention. Reconstructive surgery becomes necessary in cases of end-stage IC/BPS where various therapeutic approaches have failed. Patient selection is crucial in reconstructive surgery, particularly for patients with clear Hunner lesions and small bladder capacity who have not responded to previous treatments. Furthermore, it is vital to consider the patients' expectations and preferences adequately. Based on a comprehensive review of the literature and our own clinical experiences, subtotal cystectomy followed by bladder augmentation is considered a safe and effective surgical option. This stepwise and tailored therapeutic approach aims to optimize patients' quality of life by specifically targeting Hunner-type IC.
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Affiliation(s)
- Jiwoong Yu
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chung Un Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Research Institute for Future Medicine Samsung Medical Center, Seoul, Republic of Korea
| | - Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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2
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Rahnama’i MS, Marand AJB, Janssen D, Mostafaei H, Gatsos S, Hajebrahimi S, Apostolidis A, Taneja R. Botulinum Toxin Therapy for Bladder Pain Syndrome/Interstitial Cystitis. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Abstract
Purpose of Review
Bladder pain syndrome (BPS)/interstitial cystitis (IC) can also be classified as either non-ulcerative or ulcerative, corresponding to the characteristic cystoscopic findings under hydrodistention. Promising therapeutic effects, including decreased bladder pain, have been reported from recent clinical trials using botulinum toxin A (BoNTA) for the treatment of BPS/IC. This review summarizes the current state of the literature on the underlying mechanisms of BoNTA therapy in BPS/IC as well as new forms of its application.
Recent Findings
BoNTA has its effect in the central nervous system in the afferent nerves as well as in the bladder wall. Besides the well-known effects of BoNTA in the nervous system, pain control as well as reduction of urinary urgency in BPS patients could be achieved by mast cell stabilization effecting histamine release as well as modulation of TRPV and PGE2 pathways, among other systems. In addition, new forms of BoNTA administration have focused on intravesical instillation of the drug in order to circumvent bladder wall injections. Hyperthermia, intravesical hydrogel, and lysosomes have been studied as new ways of BoNTA application in BPS/IC patients. From the available studies, bladder instillation of BoNTA in combination with EMDA is the most promising and effective novel approach.
Summary
The most promising novel application methods for BoNTA in patient with BPS/IC are bladder instillations. Future research needs to point out if bladder instillations with BoNTA with some form of bladder absorption enhancement such as hyperthermia or EMDA would be able to replace BoNTA injections in patients with BPS/IC
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3
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Taneja R, Pandey S, Priyadarshi S, Goel A, Jain A, Sharma R, Purohit N, Bandukwalla V, Tanvir, Ragavan M, Agrawal A, Shah A, Girn Z, Ajwani V, Mete U. Diagnostic and therapeutic cystoscopy in bladder pain syndrome/interstitial cystitis: systematic review of literature and consensus on methodology. Int Urogynecol J 2023:10.1007/s00192-023-05449-w. [PMID: 36708406 DOI: 10.1007/s00192-023-05449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/31/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Cystoscopy has been routinely performed in patients suspected to be suffering from bladder pain syndrome/interstitial cystitis (BPS/IC) across the globe. The methodology reported by various guidelines appears to have differences in the techniques and hence there is a need for a review of all those techniques in order to arrive at a consensus. The aim was to review the literature describing the prevalent techniques of cystoscopy for patients of BPS/IC and try to evolve a consensus. METHODS The group the Global Interstitial Cystitis, Bladder Pain Society (GIBS) has worked collectively to systematically review the literature using the key words, "Cystoscopy in Hunner's lesions, bladder pain syndrome, painful bladder syndrome and interstitial cystitis" in the PubMed, COCHRANE, and SCOPUS databases. A total of 3,857 abstracts were studied and 96 articles referring to some part of technique of cystoscopy were short-listed for review as full-length articles. Finally, six articles with a description of a technique of cystoscopy were included for final tabulation and comparison. The group went on to arrive at a consensus for a stepwise technique of diagnostic and therapeutic cystoscopy in cases of BPS/IC. This technique has been compared with the previously described techniques and may serve to be a useful practical guide for treating physicians. CONCLUSION It is important to have a uniform standardized technique for performing a diagnostic and therapeutic cystoscopy in patients with BPS/IC. Consensus on one such a technique has been arrived at and described in the present article.
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Affiliation(s)
- Rajesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, 110070, India.
| | - Sanjay Pandey
- Urology and Renal Transplant, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | | | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, India
| | - Amita Jain
- Institute of Urology and Robotics, Medanta The Medicity, Gurugram, India
| | - Ranjana Sharma
- Gynecology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Navita Purohit
- Department of Physiatry, Kokilaben Dhitubhai Ambani hospital, Mumbai, India
| | | | - Tanvir
- Tanvir Hospital, Hyderabad, India
| | | | | | - Amit Shah
- Surgery and Urology, Naval Hospital, Mumbai, India
| | | | - Vikky Ajwani
- The Cure Urology Hospital, Vadodara, Gujarat, India
| | - Uttam Mete
- Urology and Robotic Surgery, PGIMER, Chandigarh, India
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Abreu-Mendes P, Ferrão-Mendes A, Botelho F, Cruz F, Pinto R. Effect of Intratrigonal Botulinum Toxin in Patients with Bladder Pain Syndrome/Interstitial Cystitis: A Long-Term, Single-Center Study in Real-Life Conditions. Toxins (Basel) 2022; 14:775. [PMID: 36356025 PMCID: PMC9692970 DOI: 10.3390/toxins14110775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
The high percentage of treatment failures seen in patients with bladder pain syndrome/interstitial cystitis (BPS/IC) managed conservatively frequently demands invasive treatment options. We aimed to evaluate the long-term efficacy and adverse events of intratrigonal botulinum toxin injection in such circumstances, as well as to determine possible predictors of response to toxin treatment. A retrospective cohort study included 47 female BPS/IC patients treated with onabotulinum toxin A (OnabotA) in a tertiary hospital between the years 2009 and 2022. All patients received 100 U of OnabotA in ten injections limited to the trigonal area. Patients were divided into three groups based on their treatment response as responders, non-responders and lost to follow-up due to non-medical reasons. The clinical and surgical records of the individuals were retrieved, including the 10-point visual analogue scale (VAS), the number of treatments, the time between injections, and the age at the first injection. A total of 25 patients (>50% of the cohort) were long-term responders, but none of the evaluated parameters was a predictor for this circumstance: age, pain intensity, or duration of improvement following the injection. The time between injections was stable (around 1 year). No severe adverse events were registered. The intratrigonal injection of botulinum toxin in patients with BPS/IC was an effective and safe long-term treatment for patients' refractory to conservative forms of treatment. Age, basal pain intensity, and time to injection request did not predict long-term response to OnaBotA.
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Affiliation(s)
- Pedro Abreu-Mendes
- Department of Urology, São João Universitary Hospital Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | | | - Francisco Botelho
- Department of Urology, São João Universitary Hospital Center, 4200-319 Porto, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
| | - Francisco Cruz
- Department of Urology, São João Universitary Hospital Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Rui Pinto
- Department of Urology, São João Universitary Hospital Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
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Clinical Approach to Recurrent Voiding Dysfunction, Dysuria, and Pelvic Pain Persisting for at Least 3 Months. Int Neurourol J 2022; 26:179-189. [PMID: 36203251 PMCID: PMC9537430 DOI: 10.5213/inj.2244200.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/18/2022] [Indexed: 11/08/2022] Open
Abstract
There are several patients with urination problems and urethral and pelvic discomfort. Usually, these patients’ symptoms are persistent and ambiguous; therefore, it is difficult to find underlying diseases associated with the patient’s symptoms. In addition, there are various conditions such as overactive bladder, cystitis, and interstitial cystitis/bladder pain syndrome (IC/BPS). Sometimes patients with other chronic disorders such as fibromyalgia, inflammatory bowel syndrome, and vulvodynia show urination problems and pelvic pain. Thus, a patient-centered approach is important to find the cause of chronic urination problems and pelvic pain. Moreover, IC/BPS should be considered during the diagnostic process because the clinical characteristics of IC/BPS are diverse. In this narrative review, we suggest an integral approach for the diagnosis and treatment of IC/ BPS.
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6
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Kuo HC. Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do? Toxins (Basel) 2022; 14:toxins14070498. [PMID: 35878235 PMCID: PMC9324011 DOI: 10.3390/toxins14070498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
Botulinum toxin A (Botox) had been considered a promising drug that has an effect on functional disorders of the lower urinary tract. Because Botox exhibits anti-inflammatory and antispasmodic effects, Botox injection into the bladder can decrease detrusor contractility, reduce bladder hypersensitivity, and eliminate painful sensations. Injecting Botox into the bladder outlet can relax the hyperactivity of the bladder neck, and of the urethral smooth and striated muscles. Based on these therapeutic effects, Botox has been widely applied to treat lower-urinary-tract dysfunctions (LUTDs) such as overactive bladder and neurogenic detrusor overactivity. However, this treatment has not been licensed for use in other LUTDs such as interstitial cystitis, voiding dysfunction due to benign prostatic hyperplasia in men, and dysfunctional voiding in women. Botox has also not been approved for the treatment of children with overactive bladder and dysfunctional voiding; in patients with spinal cord injuries with detrusor sphincter dyssynergia and autonomic dysreflexia; or for poorly relaxed external sphincter in non-neurogenic patients. This article reviews the current knowledge regarding Botox treatment for LUTDs and discusses the potential clinical applications of Botox, as well as work that can be conducted in the future.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 97004, Taiwan
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7
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Botulinum Toxin for Neurogenic and Non-neurogenic Bladder Pain. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-021-00640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Yunfeng G, Fei L, Junbo L, Dingyuan Y, Chaoyou H. An indirect comparison meta-analysis of noninvasive intravesical instillation and intravesical injection of botulinum toxin-A in bladder disorders. Int Urol Nephrol 2022; 54:479-491. [PMID: 35044552 DOI: 10.1007/s11255-022-03107-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A) intravesical instillation and BTX-A intravesical injection are both effective treatments or overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS), but direct comparative studies of the two treatments are lacking. METHODS We conducted a pairs-comparison meta-analysis and an adjusted indirect comparison meta-analysis extracting published data from randomized controlled trials in literature databases from the inception of each database to Aug. 31, 2021, evaluating efficacy and safety of BTX-A intravesical instillation and BTX-A intravesical injection. We also carried out a subgroup analysis. RESULTS We identified 24 trials in 21 studies were included in our study, of which 18 trials in 17 studies were BTX-A intravesical injections, 6 trials in 4 studies were BTX-A intravesical instillation. Compared with the normal saline injection, BTX-A intravesical injections for patients with OAB and IC/ BPS can obviously improve the symptoms of urinary frequency, urgency episode, UI and UUI, but BTX-A significantly increased the rate of urinary retention and urinary tract infection and increased PVR (p < 0.05). Adjusted indirect comparison meta-analysis showed that BTX-A intravesical injections was more effective than BTX-A intravesical instillation (p > 0.05). Surprisingly, BTX-A intravesical instillation had fewer side effects than BTX-A intravesical injections (p < 0.05). CONCLUSIONS Although BTX-A intravesical injections of OAB and IC/BPS has been significantly superior the BTX-A intravesical instillation, it has major side effects, but this needs to be confirmed by more large-scale, multicenter, direct comparison randomized controlled trials.
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Affiliation(s)
- Gao Yunfeng
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Lai Fei
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Liu Junbo
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Yang Dingyuan
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China
| | - Huang Chaoyou
- Department of Urology, Chengdu Second People's Hospital, Chengdu, China.
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Tailor V, Torella M, Manriquez V, Digesu GA. Understanding bladder pain syndrome/interstitial cystitis. Int Urogynecol J 2020; 31:1495-1496. [PMID: 32095957 DOI: 10.1007/s00192-020-04232-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Visha Tailor
- Imperial College Healthcare, Department of Urogynaecology, St Mary's Hospital, London, UK.
| | - Marco Torella
- Department of Obstetrics and Gynecology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Valentin Manriquez
- Pelvic Floor Unit, Obstetrics and Gynecology Department, Clinical Hospital, Universidad de Chile, Santiago, Chile
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Garzon S, Laganà AS, Casarin J, Raffaelli R, Cromi A, Sturla D, Franchi M, Ghezzi F. An update on treatment options for interstitial cystitis. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2020; 19:35-43. [PMID: 32699542 PMCID: PMC7258371 DOI: 10.5114/pm.2020.95334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022]
Abstract
Interstitial cystitis or bladder pain syndrome (IC/BPS) is a chronic pelvic pain syndrome related to the urinary bladder. The ideal treatment should match as much as possible with the pathophysiologic causes of the IC/BPS, but the scarcely available evidence limits this approach, with the majority of available treatments that are primarily targeted to the control of symptoms. The treatment strategies have traditionally focused on the bladder, which is considered the primary end-organ and source of pain. Nevertheless, the growing body of evidence suggests a multifaceted nature of the disease with systemic components. In general, guidelines recommend the personalized and progressive approach, that starts from the more conservative options and then advances toward more invasive and combined treatments. The behavioral changes represent the first and most conservative steps. They can be combined with oral medications or progressively with intravesical instillation of drugs, up to more invasive techniques in a combined way. Despite the multiple available options, the optimal treatment is not easy to be found. Only further investigation on the etiopathogenetic mechanisms, taking into account the differences among subgroups, and the interaction between central and peripherical factors may allow providing a real improvement in the treatment and management of these patients.
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Affiliation(s)
- Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Davide Sturla
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
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11
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Marinkovic SP. Improving clinical outcomes with lower motor voltage (≤3 V) during stage 1 sacral neuromodulation for interstitial cystitis or bladder pain syndrome. Neurourol Urodyn 2019; 38:2233-2241. [DOI: 10.1002/nau.24123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/03/2019] [Indexed: 12/27/2022]
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12
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Giannantoni A, Gubbiotti M, Bini V. Botulinum Neurotoxin A Intravesical Injections in Interstitial Cystitis/Bladder Painful Syndrome: A Systematic Review with Meta-Analysis. Toxins (Basel) 2019; 11:toxins11090510. [PMID: 31480323 PMCID: PMC6784147 DOI: 10.3390/toxins11090510] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/21/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
Botulinum neurotoxin A (BoNT/A) appears to be one of the best intravesical treatments for interstitial cystitis/bladder painful syndrome (IC/BPS). We aimed to point out what the evidence is regarding the effects of BoNT/A intravesically injected in patients with IC/BPS. We performed a systematic review of all randomized controlled trials (RCTs) assessing BoNT/A for IC/BPS by using Medline, EMBASE, CINAHL, CENTRAL and MetaRegister of Controlled Trials. Standardized mean differences (SMD) were extracted from the available trials and combined in a meta-analysis applying a random effect model, including heterogeneity of effects. Twelve trials were identified. Significant benefits from BoNT/A injections were detected in: Interstitial Cystitis Symptom Index and Problem Index (ICSI, ICPI) (small to medium effect size: SMD = -0.302; p = 0.007 and -0.430, p = 0.004, respectively); Visual Analog Scale (VAS) for pain and day-time urinary frequency (medium effect size: SMD = -0.576, p < 0.0001 and -0.546, p = 0.013, respectively). A great effect size was detected for post-void residual volume (PVR, SMD = 0.728; p =0.002) although no clinically relevant in most cases. Great heterogeneity was observed in treatments' methodologies and symptoms assessment. Overall, BoNT/A intravesical injections significantly improve some of the most relevant symptoms affecting IC/BPS patients.
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Affiliation(s)
- Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, 53100 Siena, Italy.
| | - Marilena Gubbiotti
- Department of Urology, San Donato Hospital, 52100 Arezzo, Italy
- Serafico Institute of Assisi, Research centre "InVita", Assisi, 06081 Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, University of Perugia, 06123 Perugia, Italy
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13
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Tandon HK, Stratton P, Sinaii N, Shah J, Karp BI. Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment. Reg Anesth Pain Med 2019; 44:rapm-2019-100529. [PMID: 31289238 PMCID: PMC6946887 DOI: 10.1136/rapm-2019-100529] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Many women with endometriosis continue to have pelvic pain despite optimal surgical and hormonal treatment; some also have palpable pelvic floor muscle spasm. We describe changes in pain, spasm, and disability after pelvic muscle onabotulinumtoxinA injection in women with endometriosis-associated pelvic pain, a specific population not addressed in prior pelvic pain studies on botulinum toxin. METHODS We present an open-label proof-of-concept case series of women with surgically diagnosed endometriosis. Under conscious sedation and with topical anesthetic, 100 units of onabotulinumtoxinA was injected transvaginally into pelvic floor muscle spasm areas under electromyography guidance. Changes in pain intensity, muscle spasm, disability, and pain medication use were assessed at periodic visits for up to 1 year after injection. RESULTS Thirteen women underwent botulinum toxin injection and were followed for at least 4 months. Before injection, 11 of the 13 women had spasm in >4/6 assessed pelvic muscles and reported moderate pain (median visual analog scale (VAS): 5/10; range: 2-7). By 4-8 weeks after injection, spasm was absent/less widespread (≤3 muscles) in all (p=0.0005). Eleven rated their postinjection pain as absent/mild (median VAS: 2; range: 0-5; p<0.0001); 7/13 reduced pain medication. Disability decreased in 6/8 women with at least moderate preinjection disability (p=0.0033). Relief lasted 5-11 months in 7 of the 11 patients followed for up to 1 year. Adverse events were mild and transient. CONCLUSIONS These findings suggest pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain. Botulinum toxin injection may provide meaningful relief of pain and associated disability. TRIAL REGISTRATION NUMBER NCT01553201.
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Affiliation(s)
- Hannah K Tandon
- Intramural Research Program, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Pamela Stratton
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Ninet Sinaii
- Biostatistics and Clinical Epidemiology Service, Intramural Research Program, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jay Shah
- Intramural Research Program, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Barbara I Karp
- Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
One of the most important goals of palliative medicine and hospice care is pain relief. Although great strides have been made in veterinary analgesia, severe pain, especially at home, is still difficult to control. Pain control in the context of palliative medicine and hospice care is far more advanced in human medicine. Many modalities used in chronically or terminally ill humans might be adapted to animals to better manage severe pain. This article discusses drugs and procedures used to control pain in humans that are relatively nascent or unavailable in veterinary medicine and deserve further attention.
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Affiliation(s)
- Jordyn M Boesch
- Section of Anesthesiology and Pain Medicine, Department of Clinical Sciences, Cornell University Hospital for Animals, Cornell University College of Veterinary Medicine, 930 Campus Road, Box 32, Ithaca, NY 14853, USA.
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15
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Lee HY, Doo SW, Yang WJ, Song YS, Sun HY, Nho EJ, Lee B, Kim JH. Efficacy and Safety of Noninvasive Intravesical Instillation of Onabotulinum Toxin-A for Overactive Bladder and Interstitial Cystitis/Bladder Pain Syndrome: Systematic Review and Meta-analysis. Urology 2018; 125:50-57. [PMID: 30552935 DOI: 10.1016/j.urology.2018.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of noninvasive intravesical instillation of onabotulinum toxin-A (OBTX-A) through systematic review and meta-analysis. Recently, several studies of noninvasive intravesical instillation of OBTX-A have been published. However, its efficacy is not well validated yet compared to well-known efficacy of minimally invasive intravesical injection of OBTX-A. METHOD Systematic review and meta-analysis were performed to evaluate the efficacy of noninvasive intravesical instillation of OBTX-A in patients with overactive bladder and interstitial cystitis/bladder pain syndrome by measuring outcomes such as urgency episode per 72 hours, frequency per 72 hours, urgency urinary incontinence, voided volume (VV), postvoided residual volume, maximum flow rate, and patient perception of bladder condition. RESULT Six trials in 4 studies that compared instillation of OBTX-A and placebo involving 248 patients (121 experimental and 127 controls) were included for final data extraction. Instillation of OBTX-A significantly increased VV, with a mean difference of 38.48 (95% confidence interval: 76.05, 0.92) compared to the placebo group. However, other outcomes showed statistically insignificant changes. Major adverse events were not reported in the group receiving intravesical instillation of OBTX-A. CONCLUSION Intravesical instillation of OBTX-A showed limited efficacy with improvement of VV for treatment of overactive bladder or interstitial cystitis/bladder pain syndrome. More studies are needed to overcome the efficacy of current noninvasive bladder instillation of OBTX-A regarding effective drug transport.
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Affiliation(s)
- Hyun Young Lee
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | - Seung Whan Doo
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | - Yun Seob Song
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | - Hwa Yeon Sun
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea
| | | | - Bora Lee
- Department of Statistics, Graduate School of Chung-Ang University, Seoul, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University Medical College, Seoul, South Korea.
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What Is New in Bladder Pain?: Best Articles From the Past Year. Obstet Gynecol 2018; 132:1296-1299. [PMID: 30303913 DOI: 10.1097/aog.0000000000002951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This month we focus on current research in bladder pain. Dr. Whiteside discusses four recent publications, which are concluded with a "bottom-line" that is the take-home message. A complete reference for each can be found in on this page along with direct links to abstracts.
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Henningsen P, Zipfel S, Sattel H, Creed F. Management of Functional Somatic Syndromes and Bodily Distress. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:12-31. [PMID: 29306954 DOI: 10.1159/000484413] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient.
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Affiliation(s)
- Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Abstract
The management of chronic pelvic pain poses a significant challenge to both physicians and patients. Patients should be evaluated for both gynecologic and nongynecologic conditions, and >1 source may be identified. Treatment involves medical as well as surgical options, and it is important to set realistic goals with patients. Treatment may not be curative, but should improve the patient's quality of life.
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Rahnama'i MS, Marcelissen T, Apostolidis A, Veit-Rubin N, Schurch B, Cardozo L, Dmochowski R. The efficacy of botulinum toxin A and sacral neuromodulation in the management of interstitial cystitis (IC)/bladder pain syndrome (BPS), what do we know? ICI-RS 2017 think thank, Bristol. Neurourol Urodyn 2018; 37:S99-S107. [PMID: 29363792 DOI: 10.1002/nau.23493] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Abstract
AIMS This manuscript aims to address the evidence availale in the literature on the efficacy of Botulinum Toxin A (BoNT-A) and sacral neuromodulation (SNM) in patients suffering from Interstitial Cystitis (IC)/BPS and propose further research to identify mechanisms of action and establish the clinical efficacy of either therapy. METHODS At the International Consultation on Incontinence-Research Society (ICI-RS) in 2017, a panel of Functional Urologists and Urogynaecologists participated in a Think Tank (TT) discussing the management of IC/BPS by BoNT-A and SNM, using available data from both PubMed and Medicine literature searches. RESULTS The role of BoNT-A and SNM in the treatment of IC/BPS are discussed and mechanisms of actions are proposed. Despite the available randomized trial data on the effect of intravesical BoNT-A treatment on symptoms of IC/BPS, a consistent conclusion of a positive effect cannot be drawn at the moment, as the published studies are small and heterogeneous in design. There is substantive evidence for the positive effects of SNM on symptoms of IC/BPS patients however, during patient selection, it is important to distinguish the degree and the location of pain in order to tailor the best therapy to the right patients. CONCLUSIONS Both intravesical BoNT-A treatment and SNM have been shown to have positive effects in patients with IC/BPS. However, firm conclusions cannot yet be drawn. Patient-reported outcomes and quality of life should be assessed in addition to urinary and pain symptoms. Since current treatments mainly focus on symptomatic relief, future research should also focus on clarifying the pathogenic mechanisms involved in IC/BPS.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Brigitte Schurch
- Department of Clinical Neuroscience, Neuropsychology & Neurorehabilitation Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Linda Cardozo
- Department of Urogynaecology, Kings College Hospital, London, United Kingdom
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennesse
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Zhang W, Deng X, Liu C, Wang X. Intravesical treatment for interstitial cystitis/painful bladder syndrome: a network meta-analysis. Int Urogynecol J 2016; 28:515-525. [PMID: 27614759 DOI: 10.1007/s00192-016-3079-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/14/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic inflammatory condition of the submucosal and muscular layers of the bladder. So far, there is no effective and targeted treatment strategy for IC/PBS. This study aimed to assess the efficacy and safety of intravesical instillation treatment in IC/PBS patients. METHODS We searched various databases up to October 2015. A network meta-analysis was performed to compare global response assessment (GRA) for different treatment strategies, including botulinum toxin A (BoNTA), bacillus Calmette-Guerin (BCG), resiniferatoxin (RTX), lidocaine, chondroitin sulfate (CS), oxybutynin, and pentosan polysulfate (PPS). A traditional meta-analysis was also performed. RESULTS Sixteen trials evaluating 905 patients were included. Network meta-analysis indicated that BoNTA had the highest probability of being the best treatment course according to GRA assessment results (probability 81.7 %). BCG or BoNTA therapy yielded significant improvement in GRA incidence according to traditional meta-analysis. Patients who received PPS showed higher urinary frequency results compared with the placebo groups. BCG- and PPS-treated patients had elevated urinary urgency treatment effects compared with placebo groups. Bladder capacity restoration results also showed significant improvements in patients who received BoNTA compared with placebo-treated individuals. CONCLUSIONS These findings indicate that BoNTA therapy has the highest probability of being the best therapy according to GRA, and significantly improves bladder capacity in IC/PBS patients. BCG treatment also significantly increases the incidence of GRA and improves the symptoms of urinary urgency. PPS can significantly improve urinary frequency and urgency symptoms in IC/PBS patients.
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Affiliation(s)
- Wei Zhang
- Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Xiaojing Deng
- Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Chunyu Liu
- Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Xu Wang
- Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
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