scholarly journals Therapeutic Effect of Botulinum Toxin A on Sensory Bladder Disorders—From Bench to Bedside

Toxins ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 166 ◽  
Author(s):  
Yuan-Hong Jiang ◽  
Wan-Ru Yu ◽  
Hann-Chorng Kuo
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Bladder Capacity ◽  
Active Management ◽  
Toxin A ◽  
Bladder Pain ◽  
Detrusor Contractility ◽  
Intravesical Injection ◽  
Bladder Symptoms ◽  
Bladder Disorders

Bladder oversensitivity arises from several different conditions involving the bladder, bladder outlet, systemic or central nervous system diseases. Increase of the bladder sensation results from activation of the sensory receptors in the urothelial cells or suburothelial tissues. Medical treatment targeting the overactive bladder (OAB) or interstitial cystitis (IC) might relieve oversensitive bladder symptoms (frequency, urgency and pain) in a portion of patients, but a certain percentage of patients still need active management. Botulinum toxin A (BoNT-A) has been demonstrated to have anti-inflammatory and antinociceptive effects in bladder sensory disorders and has been shown effective in the reduction of bladder oversensitivity and the increase of functional bladder capacity. For patients with OAB, urgency and urinary incontinence improved, while in patients with IC, bladder pain could be relieved in association with reduction of bladder oversensitivity after BoNT-A intravesical injection. Histological evidence has confirmed the therapeutic mechanism and clinical efficacy of intravesical BoNT-A injection on patients with OAB or IC. Bladder oversensitivity can also be relieved with the instillation of liposome encapsulated BoNT-A or low energy show waves (LESWs), which enable the BoNT-A molecule to penetrate into the urothelium and suburothelial space without affecting the detrusor contractility. Liposome encapsulated BoNT-A or combined LESWs and BoNT-A instillation might be future treatment alternatives for bladder oversensitivity in sensory bladder disorders.

scholarly journals Intravesical Botulinum Toxin A Injections Do Not Benefit Patients with Ulcer Type Interstitial Cystitis

2013 ◽  
Vol 2;16 (2;3) ◽  
pp. 109-116
Author(s):  
Hann-Chorng Kuo
Keyword(s):  
Botulinum Toxin ◽  
Treatment Outcomes ◽  
Interstitial Cystitis ◽  
General Hospital ◽  
Botulinum Toxin A ◽  
Bladder Capacity ◽  
Toxin A ◽  
Bladder Pain ◽  
End Point ◽  
Institutional Review

Background: Ulcer type and non-ulcer type interstitial cystitis/bladder pain syndromes (IC/BPS) are considered different disease entities. Thus, intravesical botulinum toxin A (BoNT-A) treatment outcomes could differ for each entity. Objectives: To evaluate and compare the treatment outcomes of BoNT-A injections for treatment of each IC/BPS type. Study Design: Prospective interventional study. Setting: Tertiary medical center affiliated with Buddhist Tzu Chi General Hospital and Tzu Chi University, Taiwan. Methods: Forty-four consecutive patients with IC/BPS for whom conventional treatments failed were prospectively enrolled in this study. Patients were classified as having ulcer (n = 10) or non-ulcer (n = 30) IC/BPS based on their previous cystoscopic findings. Intervention: All patients received 4 sets of intravesical BoNT-A injections (100 U in 40 suburothelial injections) every 6 months. The primary end-point was the global response assessment (GRA) 6 months after the fourth set of BoNT-A injections. Secondary end-points included the O’Leary-Sant score (OSS) including symptom indexes (ICSI) and problem indexes (ICPI), visual analog scale (VAS) pain score, voiding diary, and urodynamics variables. Results: After 4 sets of BoNT-A injections, 15 patients with non-ulcer IC/BPS had GRA scores ≥ 2, while the other 15 had GRA scores < 2. All 10 patients with ulcer IC/BPS had GRA scores < 2 at the study end-point (treatment failure). At baseline, patients with ulcer IC/BPS had significantly higher daytime frequency, nocturia, smaller functional bladder capacity, smaller voided volume, greater VAS, smaller maximal bladder capacity, and greater glomerulation grade than did patients with non-ulcer IC/BPS. After 4 sets of BoNT-A injections, patients with non-ulcer IC/BPS and GRA scores ≥ 2 or < 2 all had significantly decreased ICSI, ICPI, OSS, VAS pain scores, frequency episodes, and increased functional bladder capacity. However, patients with ulcer IC/BPS showed no significant change in any clinical or urodynamic variable. After failure of repeated BoNT-A injections, all 10 patients with ulcer IC/ BPS underwent transurethral electrocauterization of their ulcers, which resulted in immediate pain relief. Limitations: Lack of a control arm in this study. Conclusion: Repeated intravesical BoNT-A injections provided effective treatment outcomes at the end-point in half of the patients with non-ulcer IC/BPS, but did not benefit any patient with ulcer type IC/BPS. Ulcer type IC/BPS should be treated as a different disease than non-ulcer IC/BPS. Institutional Review: This study was approved by the Institutional Review Board of the Tzu-chi General Hospital (TCGH 100-06). Key words: Botulinum toxin, interstitial cystitis, bladder pain syndrome, intravesical treatment, Hunner’s ulcer

358: Intravesical Botulinum Toxin a Administration Produces Analgesia Against Acetic Acid Induced Bladder Pain Responses in Rats

2004 ◽  
Vol 171 (4S) ◽  
pp. 94-94
Author(s):  
Yao-Chi Chuang ◽  
Naoki Yoshimura ◽  
Chao-Cheng Huang ◽  
Po-Hui Chiang ◽  
Michael B. Chancellor
Keyword(s):  
Acetic Acid ◽  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Toxin A ◽  
Bladder Pain ◽  
Pain Responses

scholarly journals Efficacy and Safety of Botulinum Toxin A for Treating Bladder Hyperactivity in Children and Adolescents with Neuropathic Bladder Secondary to Myelomeningocele

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Antonio Marte ◽  
Micaela Borrelli ◽  
Maurizio Prezioso ◽  
Lucia Pintozzi ◽  
Pio Parmeggiani
Keyword(s):  
Botulinum Toxin ◽  
Neurogenic Bladder ◽  
Botulinum Toxin A ◽  
Invasive Procedure ◽  
Bladder Capacity ◽  
Rank Test ◽  
Clean Intermittent Catheterization ◽  
Efficacy And Safety ◽  
Average Increase ◽  
Toxin A

We verified the efficacy and safety of botulinum toxin A (BTX-A) in treating bladder overactivity in children with neurogenic bladder (NB) secondary to myelomeningocele (MMC). Forty-seven patients (22, females; 25, males; age range, 5–17 years; mean age, 10.7 years) with poorly compliant/overactive neurogenic bladder on clean intermittent catheterization (CIC) and resistance or noncompliant to anticholinergics were injected with 200 IU of BTX-A intradetrusor. All patients experienced a significant 66.45% average increase of leak point volume (Wilcoxon paired rank test = 7.169 e-10) and a significant 118.57% average increase of specific bladder capacity at 20 cm H2O (Wilcoxon paired rank test = 2.466 e-12). Ten patients who presented with concomitant uni/bilateral grade II–IV vesicoureteral reflux were treated at the same time with Deflux. No patient presented with major perioperative or postoperative problems. Twenty-two patients needed a second and 18 a third injection of BTX-A after 6–9 months for the reappearance of symptoms. After a mean follow-up of 5.7 years, 38 out of 47 patients achieved dryness between CICs, and 9 patients improved their incontinence but still need pads. Our conclusion is that BTX-A represents a viable alternative to more invasive procedure in treatment of overactive NB secondary to MMC.

MP29-18 BOTULINUM TOXIN A BLADDER INJECTION IN THE TREATMENT OF BLADDER PAIN SYNDROME/IC: TRYING TO STANDARDIZE THE TECHNIQUE

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Cristina Gutiérrez ◽  
Carlos Errando ◽  
Nicolas Nervo ◽  
Pedro Araño ◽  
Humberto Villavicencio
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Toxin A ◽  
Bladder Pain

scholarly journals Predictive Factors for a Satisfactory Treatment Outcome with Intravesical Botulinum Toxin A Injection in Patients with Interstitial Cystitis/Bladder Pain Syndrome

Toxins ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 676 ◽  
Author(s):  
Hsiu-Jen Wang ◽  
Wan-Ru Yu ◽  
Hueih-Ling Ong ◽  
Hann-Chorng Kuo
Keyword(s):  
Treatment Outcome ◽  
Botulinum Toxin ◽  
Treatment Outcomes ◽  
Predictive Factors ◽  
Botulinum Toxin A ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Bladder Pain ◽  
Satisfactory Outcome ◽  
Intravesical Injection

A botulinum toxin A (BoNT-A) intravesical injection can improve the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Patients with IC/BPS have different clinical characteristics, urodynamic features, and cystoscopic findings. This study assessed the treatment outcomes of a BoNT-A intravesical injection and aimed to identify the predictive factors of a satisfactory outcome. This retrospective study included IC/BPS patients treated with 100 U BoNT-A. The treatment outcomes were assessed by global response assessment (GRA) at 6 months. We classified patients according to different clinical, urodynamic, and cystoscopic characteristics and evaluated the treatment outcomes and predictive factors. A total of 238 patients were included. Among these patients, 113 (47.5%) had a satisfactory outcome (GRA ≥ 2) and 125 (52.5%) had an unsatisfactory outcome. Improvements in the IC symptom score, IC problem score, O’Leary–Sant symptom score, and visual analog scale score for pain were significantly greater in patients with a satisfactory outcome than in patients with an unsatisfactory outcome (all p = 0.000). The IC disease duration and maximal bladder capacity (MBC) were significantly different between patients with and without a satisfactory outcome. Multivariate analysis revealed that only the MBC was a predictor for a satisfactory outcome. Patients with a MBC of ≥760 mL and glomerulations of 0/1 (58.7%) or glomerulations of 2/3 (75.0%) frequently had a satisfactory outcome. We found that BoNT-A intravesical injection can effectively improve symptoms among patients with IC/BPS, with a remarkable reduction in bladder pain. A MBC of ≥760 mL is a predictive factor for a satisfactory treatment outcome.

scholarly journals Effect of Botulinum Toxin A on Bladder Pain—Molecular Evidence and Animal Studies

Toxins ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 98 ◽  
Author(s):  
Ting-Chun Yeh ◽  
Po-Cheng Chen ◽  
Yann-Rong Su ◽  
Hann-Chorng Kuo
Keyword(s):  
Botulinum Toxin ◽  
Neurotransmitter Release ◽  
Animal Studies ◽  
Visceral Pain ◽  
Neuromuscular Junctions ◽  
Botulinum Toxin A ◽  
Molecular Evidence ◽  
Toxin A ◽  
Bladder Pain ◽  
Bladder Urothelium

Botulinum toxin A (BTX-A) is a powerful neurotoxin with long-lasting activity that blocks muscle contractions. In addition to effects on neuromuscular junctions, BTX-A also plays a role in sensory feedback loops, suggesting the potentiality for pain relief. Although the only approved indications for BTX-A in the bladder are neurogenic detrusor overactivity and refractory overactive bladder, BTX-A injections to treat bladder pain refractory to conventional therapies are also recommended. The mechanism of BTX-A activity in bladder pain is complex, with several hypotheses proposed in recent studies. Here we comprehensively reviewed properties of BTX-A in peripheral afferent and efferent nerves, the inhibition of nociceptive neurotransmitter release, the reduction of stretch-related visceral pain, and its anti-inflammatory effects on the bladder urothelium. Studies have also revealed possible effects of BTX-A in the human brain. However, further basic and clinical studies are warranted to provide solid evidence-based support in using BTX-A to treat bladder pain.

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