AUA 2013: Botulinum: Equal pain relief across IC phenotypes

Trigonal onabotulinumtoxinA (Botox) brings equal analgesic relief to patients with ulcerative and non-ulcerative forms of bladder pain syndrome/interstitial cystitis (BPS/IC) alike, researchers say.

First author Rui Miguel Correia de Almeida Pinto, MD, of São João Hospital, Porto, Portugal, treated 24 refractive BPS/IC patients with intra-trigonal botulinum injections (100 U) in a trial designed to understand whether the ulcerative and non-ulcerative phenotypes of BPS/IC had different symptomatic outcomes or duration of effect. He also compared the levels of urinary neurotrophines and norepinephrine in response to botulinum.

Ten patients with ulcerative and 14 patients with non-ulcerative BPS/IC were evaluated at presentation and 1 month after intra-trigonal injection of botulinum, 100 U. Each patient received 10 injections (10 U each). In addition to a 10-point visual analogue scale to quantify pain, the authors evaluated frequency and nocturia in a 3-day voiding chart, O’Leary-Sant Score, quality of life (QoL), and duration of effect.

Urinary nerve growth factor, brain-derived neurotrophic factor, glial cell line-derived neurotrophic factor, and norepinephrine were assessed by ELISA.

Patients with the ulcerative phenotype had a longer duration of symptoms than those without ulcers (28.8±11 vs. 19.2±8 months, respectively, p=.018). The duration of effects was similar-9±2.8 months in the ulcerative group versus 10.5±2 months in the non-ulcerative group-which was statistically insignificant, Dr. Pinto observed.

The two groups responded equally to botulinum with a marked decrease in pain, frequency, nocturia, O’Leary-Sant, QoL, and in urinary neurotrophines and norepinephrine levels.