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Toxins (Basel). 2019 Aug 30;11(9). pii: E510. doi: 10.3390/toxins11090510.

Botulinum Neurotoxin A Intravesical Injections in Interstitial Cystitis/Bladder Painful Syndrome: A Systematic Review with Meta-Analysis.

Author information

1
Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, 53100 Siena, Italy. antonella.giannantoni@unisi.it.
2
Department of Urology, San Donato Hospital, 52100 Arezzo, Italy.
3
Serafico Institute of Assisi, Research centre "InVita", Assisi, 06081 Perugia, Italy.
4
Department of Medicine, University of Perugia, 06123 Perugia, Italy.

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.

KEYWORDS:

abobotulinumtoxin A; bladder painful syndrome; botulinum neurotoxin A; chronic pelvic pain; interstitial cystitis; intravesical injection; neuropathic pain; onabotulinumtoxinA

PMID:
31480323
DOI:
10.3390/toxins11090510
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