Abstract
To evaluate the outcome, safety, and patient's tolerability of repeated intravesical onabotulinumtoxinA (BOTOX) injection for interstitial cystitis (IC)/bladder pain syndrome (PBS).
The medical charts of 26 adult patients (four males and 22 females, with a mean age of 40.9 years) who underwent BOTOX injections for IC/PBS from March 2010 to June 2017 were retrospectively reviewed. BOTOX injections of 100, 150 or 200 U were given depending on patient's condition and side-effects. Preoperative and intraoperative data, and pre, same day postoperative and 4-months postoperative treatment pain scores via visual analogue scale (VAS) scoring, were collected from the files. The patient's satisfaction rate was assessed through a short survey: 'fully satisfied', 'partially satisfied', or 'not satisfied', if the patient would repeat the injections, and if the patient would recommend this therapy to other patients.
In all, 26 charts were reviewed. Overall, the patients underwent a total of 114 procedures. Repeat procedures (at least twice) were required in 23/26 patients (88.46%), with a mean of 5.15 procedures/patient and a mean of 10.64 months between injections. The mean operative time was 7.2 min. In all, 13 patients received 200 U BOTOX, six received 100 U, and seven received 150 U. Dose adjustment was performed in 10 patients. The VAS pain score dropped to 0.62 after the procedure from 8.7 at the time of the diagnosis of IC/PBS. Five of the 26 patients had classic bladder ulcerations and three had complete resolutions of ulcers after two repeated intravesical BOTOX injections, and the remaining two had significant improvement (>50%) in their ulcers. There were no major intraoperative or postoperative complications. Postoperative urinary retention occurred in three patients, and they were managed by clean intermittent catheterisation. Another three patients had urinary tract infections but did not require admission. In all, 16 of 23 patients were fully satisfied and seven of 23 partially satisfied. About 88% of patients would repeat the treatment and 77% of them would recommend the treatment to other patients.
Repeated intravesical BOTOX injection is an effective, well-tolerated, and safe treatment modality for patients with IC/PBS. It has very good outcomes in controlling pain symptoms and treating bladder ulcers.