Hydrodistension plus Onabotulinumtoxin A in bladder pain syndrome refractory to conservative treatments

• Published in: Actas urológicas españolas (English ed.) 2016-06, Vol.40 (5), p.303-308
• Main Authors: Lorenzo, L, Bonillo, M.A, Arlandis, S, Martínez-Cuenca, E, Marzullo, L, Broseta, E, Boronat, F
• Format: Article
• Language: English
• Subjects: Bladder pain syndrome; Cistitis intersticial; Hidrodistensión; Hunner's lesion; Hydrodistention; Interstitial cystitis; Lesión de Hunner; Onabotulinumtoxin A; Síndrome de dolor vesical; Urology
• ISSN: 2173-5786; 2173-5786
• DOI: 10.1016/j.acuroe.2016.03.007

Abstract Introduction For bladder pain syndrome (BPS) refractory to conservative treatment, the European guidelines consider bladder hydrodistention (HD) under anesthesia and the injection of Onabotulinumtoxin A (OnabotA) jointly. The objective of this study was to assess our experience in implementing this technique. Material and methods A prospective study of 25 patients with BPS who underwent HD plus a submucosal injection of 100 U of OnabotA in trigone. The Hunner lesions were treated endoscopically using resection or electrocoagulation. Thirty-eight procedures were performed (25 first interventions and 13 reoperations). To study the clinical change, we evaluated the subjective improvement (Treatment Benefit Scale [TBS] and Patient Global Impression of Change [PGIC] scales), the visual analog scale (VAS) for pain, the Bladder Pain/Interstitial Cystitis Symptom Score (BPIC-SS) questionnaire and the voiding diary for 3 days. For the data analysis, we employed the Wilcoxon, Kruskal–Wallis, Kaplan–Meier and log-rank tests. Results We observed subjective improvement in 21 patients (84%), which was significant in 47% of these patients, moderate in 41.2% and slight in 11.8%. Four patients did not improve. A post-treatment reduction in the pain VAS (from 7.1 to 1.8 points; p = .001), in daytime (from 11.8 to 7.5; p = .012) and night-time (from 5.9 to 3.6; p = .003) voiding frequency and in the BPIC-SS (from 27.9 to 11.2 points; p = .042). The degree of improvement was not related to age, the presence of bladder lesions or the treatment of relapses. The median duration of improvement was 7 months (95% CI: 5.69–8.31), although this duration was somewhat longer for the patients younger than 65 years. Mild complications occurred in 23.7% of the cases. Conclusions The joint implementation of HD plus OnabotA is a valid therapeutic option in refractory BPS, which provides good clinical results and maintains its effectiveness in retreatments.