Evaluation of pain and quality of life after hyaluronic acid instillation in addition to botulinum toxin-A injection in women with refractory Interstitial Cystitis/Painful Bladder Syndrome: A pilot study
https://doi.org/10.4081/aiua.2022.4.447
Accepted: November 19, 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Objectives: The aim of this study was to assess changes in quality of life and pain alleviation in women with refractory Interstitial Cystitis/Painful Bladder syndrome following a combined intravesical injection of Botulinum Toxin-A and Hyaluronic Acid instillation versus Hyaluronic acid instillation alone.
Methods: Two groups of women with painful bladder syndrome/interstitial cystitis were randomly divided (one to one randomization). Intravesical injections of botulinum toxin-A and intravesical Hyaluronic acid were given to Group (I). Only Hyaluronic acid was instilled intravesically in Group II. Patients were given voiding diaries, a visual analogue scale for pelvic pain, the International Cystitis Symptom Index and Problem Index, the Pelvic Pain Urgency/Frequency Patient Symptom Scale, and the Patient Health Questionnaire-9 to assess the candidates' quality of life. The Student t-test and mean and standard deviation were used in statistical analysis, with p 0.05 considered as significant (IBM SPSS statistics)
Results: Thirty-four women were included in this study. The pain severity (VAS) of group (I) cases dropped dramatically from 8.5 ± 1.5 at the start to 3.9 ± 2.4 after three months and 2.9 ± 2.1 after six months. Among group (II) cases, the pain score reduced dramatically from 8.6 ± 1.3 to 5.8 ± 1.4 to 4.3 ± 2.6.
Conclusions: In patients with refractory Interstitial Cystitis/Bladder Discomfort Syndrome, Botulinum Toxin-A injection combined with Hyaluronic Acid instillation improves pelvic pain and improves quality of life.
Hung MJ, Tsai CP, Lin YH, Huang WC, Chen GD, Shen PS. Hyaluronic acid improves pain symptoms more than bladder storage symptoms in women with interstitial cystitis. Taiwan J Obstet Gynecol. 2019: 58(3); 417-422.
Hanno P, Lin A, Nordling J, Nyberg L, Ophoven A, Ueda T, Wein A. Bladder pain syndrome committee of the international consultation on incontinence. Neurourol Urodyn 2010: 29(1); 191-198.
Garzon S, Laganà AS, Casarin J, Raffaelli R, Cromi A, Sturla D, Franchi M, Ghezzi F. An update on treatment options for interstitial cystitis. Prz Menopauzalny 2020: 19(1); 35-43.
Lai MC, Kuo YC, Kuo HC. Intravesical hyaluronic acid for interstitial cystitis/painful bladder syndrome: A comparative randomized assessment of different regimens. International Journal of Urology 2013: 20; 203-207.
Wein AJ, Hanno PM. Targets for therapy of the painful bladder. Urology 2002: 59; 68-73.
Jhang JF, Kuo HC. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA injection. Toxins (Basel) 2015: 18; 7(6): 2232-2250.
Grover S, Srivastava A, Lee R, Tewari A, Te A. Role of inflammation in bladder function and interstitial cystitis. Ther Adv Urol. 2011: 3(1); 19-33.
Parsons CL. The role of the urinary epithelium in the pathogenesis of interstitial cystitis/prostatitis/urethritis. Urology 2007: 69; 9-16.
Teichman JM, Moldwin R. The role of the bladder surface in interstitial cystitis/painful bladder syndrome. Can J Urol. 2007: 14 (4); 3599-3607.
Gao Y, Liao L. Intravesical injection of botulinum toxin A for treatment of interstitial cystitis/bladder pain syndrome: 10 years of experience at a single center in China. Int Urogynecol J 2015: 26; 1021-1026.
Kuo HC, Chancellor MB. Comparison of intravesical BTX-A injections plus HD with HD alone for the treatment of refractory interstitial cystitis/painful bladder syndrome. BJU Int. 2009: 104 (5); 657-61.
Kuo HC, Jiang YH, Tsai YC, Kuo Y. Intravesical botulinum toxin-A injections reduce bladder pain of interstitial cystitis/bladder pain syndrome refractory to conventional treatment - A prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial. Neurourol Urodyn. 2016: 35(5); 609-6014.
Smith CP, Radziszewski P, Borkowski A, Somogyi G, Boone T, Chancellor M. Botulinum toxin A has antinociceptive effects in treating interstitial cystitis. Urology 2004: 64; 871-875.
Akiyama Y, Nomiya A, Niimi A, Yamada Y, Fujimura T, Nakagawa T, Fukuhara H, Kume H, Igawa Y, Homma Y. Botulinum toxin type A injection for refractory interstitial cystitis: A randomized comparative study and predictors of treatment response. Int J Urol. 2015: 22(9); 835-41.
Shim SR, Cho YJ, Shin IS, Kim J. Efficacy and safety of botulinum toxin injection for interstitial cystitis/bladder pain syndrome: a systematic review and meta-analysis. Int Urol Nephrol. 2016: 48; 1215-1227.
Pinto R, Lopes T, Frias B, Silva A, Silva J, Silva C, Cruz C, Cruz F, Dinis P. Trigonal Injection of Botulinum Toxin A in Patients with Refractory Bladder Pain Syndrome/Interstitial Cystitis. European Urology 2010: 58; 360-365.
Kim A, Lim B, Song M, Choo M. Pretreatment Features to Influence Effectiveness of Intravesical Hyaluronic Acid Instillation in Refractory Interstitial Cystitis/Painful Bladder Syndrome. Int Neurourol J. 2014: 18; 163-167.
Akbay E, Çayan S, Kılınç C, Bozlu M, Tek M, Efesoy O. The short-term efficacy of intravesical instillation of hyaluronic acid treatment for bladder pain syndrome/interstitial cystitis. Turk J Urol. 2019: 45(2); 129-34.
Peng YC, Chiu SY, Feng M, Liang C. The effect of intravesical hyaluronic acid therapy on urodynamic and clinical outcomes among women with interstitial cystitis/bladder pain syndrome. Taiwan J Obstet Gynecol. 2020: 59; 922-926.
Cervigni M, Natale F, Nasta L, Padoa A, Voi R, Porru D. A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J. 2008: 19; 943-947.
Pyo JS, Cho WJ. Systematic Review and Meta-Analysis of Intravesical Hyaluronic Acid and Hyaluronic Acid/Chondroitin Sulfate Instillation for Interstitial Cystitis/Painful Bladder Syndrome. Cell Physiol Biochem. 2016: 39; 1618-1625.
Liang CC, Lin YH, Hsieh WC, Huang L. Urinary and psychological outcomes in women with interstitial cystitis/bladder pain syndrome following hyaluronic acid treatment. Taiwanese Journal of Obstetrics & Gynecology 2018: 57; 360-363.
Lv Y, Zhou H, Mao H, Gao R, Wang Y, Xue X. Intravesical hyaluronic acid and alkalinized lidocaine for the treatment of severe painful bladder syndrome/interstitial cystitis. Int Urogynecol J. 2012: 23(12); 1715-1720.
Copyright (c) 2022 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
