Botulinum Neurotoxin A Intravesical Injections in Interstitial Cystitis/Bladder Painful Syndrome: A Systematic Review with Meta-Analysis

• Main Authors: Antonella Giannantoni, Marilena Gubbiotti, Vittorio Bini
• Format: Article
• Language: English
• Published: MDPI AG 2019-08-01
• Series: Toxins
• Subjects: interstitial cystitis; bladder painful syndrome; chronic pelvic pain; neuropathic pain; botulinum neurotoxin A; onabotulinumtoxinA; abobotulinumtoxin A; intravesical injection
• Online Access: https://www.mdpi.com/2072-6651/11/9/510

Botulinum neurotoxin A (BoNT/A) appears to be one of the best intravesical treatments for interstitial cystitis/bladder painful syndrome (IC/BPS). We aimed to point out what the evidence is regarding the effects of BoNT/A intravesically injected in patients with IC/BPS. We performed a systematic review of all randomized controlled trials (RCTs) assessing BoNT/A for IC/BPS by using Medline, EMBASE, CINAHL, CENTRAL and MetaRegister of Controlled Trials. Standardized mean differences (SMD) were extracted from the available trials and combined in a meta-analysis applying a random effect model, including heterogeneity of effects. Twelve trials were identified. Significant benefits from BoNT/A injections were detected in: Interstitial Cystitis Symptom Index and Problem Index (ICSI, ICPI) (small to medium effect size: SMD = &#8722;0.302; <i>p</i> = 0.007 and &#8722;0.430, <i>p</i> = 0.004, respectively); Visual Analog Scale (VAS) for pain and day-time urinary frequency (medium effect size: SMD = &#8722;0.576, <i>p</i> &lt; 0.0001 and &#8722;0.546, <i>p</i> = 0.013, respectively). A great effect size was detected for post-void residual volume (PVR, SMD = 0.728; <i>p</i> =0.002) although no clinically relevant in most cases. Great heterogeneity was observed in treatments&#8217; methodologies and symptoms assessment. Overall, BoNT/A intravesical injections significantly improve some of the most relevant symptoms affecting IC/BPS patients.