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

Autores de IIS La Fe

• Laura Lorenzo Soriano

  Autor

• Miguel Ángel Bonillo García

  Autor

• Salvador Arlandis Guzmán

  Autor

• María Esther Martínez Cuenca

  Autor

• Leopoldo Marzullo Zucchet

  Autor

• Enrique Broseta Rico

  Autor

• Francisco Boronat Tormo

  Autor

Grupos

• Urología

  Leader

  Francisco Boronat Tormo

Abstract

Introduction: For bladder pain syndrome (BPS) refractory to conservative treatment, the European guidelines consider bladder hydrodistention (HD) under anaesthesia 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 analogue 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. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Bladder pain syndrome; Interstitial cystitis; Onabotulinumtoxin A; Hydrodistention; Hunner's lesion