What is the role of botulinum toxin (BTX) injections in urological pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Zermann et al reported pain relief in 11 patients with chronic prostatic pain who were treated with BTX-A (200 U) by transurethral perisphinteric injection. [89]

Giannantoni et al looked prospectively at the 2-year efficacy and tolerability of intravesical BTX-A injections in patients with painful bladder syndrome (PBS) associated with increased urinary frequency refractory to conventional treatments. [90] Preliminary assessment of the 13 participants, who were all women, included voiding diary, urodynamics, urinary tract ultrasonography, and VAS assessment of pain intensity. All patients received multiple injections of 200 U of commercially available BTX-A diluted in 20 mL NS under cystoscopic guidance.

Clinical evaluation, urodynamic studies, urinary tract ultrasonography, and VAS assessment were repeated at least twice per year during follow-up. A total of 58 injections were administered, with a mean of 4.8 ± 0.8 injections per patient. The mean interval between 2 consecutive injections was 5.25 ± 0.75 months. At 1-month and 4-month follow-ups, 10 patients reported subjective improvement. Three nonresponders to initial BTX-A intravesical treatment underwent a repeat session 3 months later with satisfactory response.

At the 1 year and 2 year follow-ups, the beneficial effect from intravesical BTX-A persisted in all patients. The authors did not observe any adverse systemic side effects during the study period. They concluded that intravesical injections of BT-XA are effective and safe, at least for medium-term management of patients with PBS. As the beneficial BTX effect gradually decreased over several months after previous treatment sessions, repeat injections of the neurotoxin were provided when needed over time.

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