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Onabotulinumtoxin a injection with or without hydrodistension for treatment of bladder pain syndrome

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Abstract

Introduction

Onabotulinumtoxin A (BoNT-A) injection has been used for bladder pain syndrome (BPS) treatment with good results. Our aim was to assess the efficacy and safety of BoNT-A injection with or without hydrodistension (HD).

Methods

Retrospective analysis of patients treated with BoNT-A injection with or without HD because of BPS between 2008 and 2014 in our department. One hundred U of Botox® was injected in the trigone and 100 U in the bladder wall. Follow-up included a VAS of pain (0–10), a patient satisfaction scale (0–10) and a treatment benefit scale (1–2: response to treatment; 3–4: non-response to treatment). Complications were classified according to the Clavien-Dindo (CD) classification. BoNT-A retreatment was offered at the patient’s request. Reasons for non-retreatment request were collected. Postoperative outcomes were compared between BoNT-A and BoNT-A + HD.

Results

Forty-one patients were included (39 females, 2 males), median age: 73 years (69–78.5). Reduction in VAS, postoperative VAS = 0, satisfaction with surgery and responders to treatment were significantly higher after BoNT-A + HD (n = 26) than after BoNT-A (n = 15). Eleven (26.8%) complications (CD ≤ 2) were detected, with no differences between treatment groups. Mean follow-up was 153 (± 83) months. Twelve (46.2%) patients in the BoNT-A + HD group and seven (46.7%) patients in the BoNT-A group requested retreatment. Lack of severe pain was a common reason for treatment discontinuation.

Conclusion

BoNT-A injection could represent a safe and effective BPS treatment. BoNT-A + HD seems to be better than BoNT-A alone for pain relief, with no significant additional morbidity.

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Authors and Affiliations

  1. Functional and Female Urology Department, Fundació Puigvert, C/Cartagena 340-350, 08025, Barcelona, Spain

    Laura Mateu Arrom, Cristina Gutierrez Ruiz, Joan Palou & Carlos Errando-Smet

  2. Chief of the Urology Department, Fundació Puigvert, C/Cartagena 340-350, 08025, Barcelona, Spain

    Joan Palou

Authors
  1. Laura Mateu Arrom
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  2. Cristina Gutierrez Ruiz
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  3. Joan Palou
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  4. Carlos Errando-Smet
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Contributions

L. Mateu: Project development, data collection, data analysis, manuscript writing.

C. Gutierrez: Project development, data collection, manuscript writing.

J. Palou: Manuscript editing.

C. Errando: Project development, data analysis, manuscript editing.

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Correspondence to Laura Mateu Arrom.

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Mateu Arrom, L., Gutierrez Ruiz, C., Palou, J. et al. Onabotulinumtoxin a injection with or without hydrodistension for treatment of bladder pain syndrome. Int Urogynecol J 32, 1213–1219 (2021). https://doi.org/10.1007/s00192-020-04451-w

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  • DOI: https://doi.org/10.1007/s00192-020-04451-w

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