OBJECTIVES: To determine whether botulinum toxin type A can represent an alternative treatment option for patients with interstitial cystitis refractory to conventional therapies.
METHODS: This is a single-center, prospective, open labeled, randomized comparative study. Patients with refractory interstitial cystitis were randomly divided into two groups: immediate injection (group A) or 1-month delayed injection (group B) of botulinum toxin type A after allocation. The rate of treatment response (global response assessment ≥+1: slightly improved), and changes in symptom scores and frequency volume chart variables were compared between groups 1 month after allocation. Using subjects of both groups as a single cohort, predictive factors for treatment response at 1 month post-injection and the duration of response were explored.
RESULTS: A total of 34 patients (group A n = 18, group B n = 16) were allocated. The response rate was significantly higher in group A than group B (72.2% vs 25.0%, P = 0.01). All symptom measures showed significant improvement in group A than group B. When both groups were combined as a single cohort, the response rate was 73.5% at 1 month, 58.8% at 3 months, 38.2% at 6 months and 20.6% at 12 months. The mean duration of response was 5.4 months. Multivariate analysis showed that past exposure to hydrodistension more than three times correlated with better outcomes.
CONCLUSIONS: Botulinum toxin type A injection could be an alternative treatment option for patients with interstitial cystitis refractory to conventional therapies, especially for those who have received repeated hydrodistensions and transurethral fulguration.
Written by:
Akiyama Y, Nomiya A, Niimi A, Yamada Y, Fujimura T, Nakagawa T, Fukuhara H, Kume H, Igawa Y, Homma Y. Are you the author?
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan.
Reference: Int J Urol. 2015 Jun 2. Epub ahead of print.
doi: 10.1111/iju.12833
PubMed Abstract
PMID: 26041274