MP49: Predictive factors for a successful treatment outcome of intravesical botulinum toxin a injection for patients with interstitial cystitis/ bladder pain syndrome
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間質性膀胱炎患者接受膀胱內肉毒桿菌毒素注射手術治療結果的預測因子分析
王脩仁、郭漢崇
花蓮慈濟醫院 泌尿部
Predictive factors for a successful treatment outcome of intravesical Botulinum Toxin A injection for patients with Interstitial Cystitis/ Bladder Pain Syndrome
Hsiu-Jen Wang, Hann-Chrong Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan  
 
Purpose: Intravesical onabotulinumtoxinA (BoNT-A) injection can relieve symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Patients with IC/BPS have different phenotypes of clinical characteristics, urodynamic, and cystoscopic findings. This retrospective study analyzed the treatment outcome and search for predictive factors for a successful treatment outcome.
Materials and Methods: Patients with IC/BPS who were treated with 100U of BoNT-A in 10ml saline injected into 20 sites were retrospectively analyzed. The treatment outcome was assessed by the global response assessment (GRA) at 6 months. We classified patients according to different clinical, urodynamic and cystoscopic characteristics (maximal bladder capacity [MBC] and glomerulation) and evaluate the treatment outcome and predictive factors.
Results: A total of 238 patients (38 males and 200 females) were included. Among them, 113 (47.5%) patients reported a successful outcome (GRA ≥ 2) and 125 (52.5%) had a unsatisfactory outcome. Patients with a GRA ≥ 2 had a significantly greater improvement of the IC symptom score, IC problem score, O’Leary Sant symptom score, and visual analog of pain score (all p=0.000) than those with a GRA ≤ 1. IC disease duration and MBC were significantly different between patients with GRA≥ 2 and GRA≤ 1. Multivariate analysis revealed that only the MBC was the predictor for a successful outcome. Patients with a MBC ≥760 ml and glomerulation of 0 or 1 (58.7%) and glomerulation of 2 or 3 (75.0%) had a successful outcome.
Conclusions: In this retrospective analysis, we found the successful result can be achieved in 47.5% of IC/BPS patients after a single BoNT-A injection, with a greater reduction of bladder pain. Patients with a MBC of ≥760ml can predict a better success rate but the glomerulation grade cannot.
 
 
Table 1. Treatment outcome based on different cystoscopic phenotype
Phenotype
GRA ≤ 1
GRA ≥ 2
Total
Glomerulation= 0,1, MBC ≥ 760 mL
19 (41.3%)
27 (58.7%)
46 (19.3%)
Glomerulation= 0,1, MBC < 760 mL
28 (60.9%)
18 (39.1%)
46 (19.3%)
Glomerulation= 2,3, MBC ≥ 760 mL
5 (25.0%)
15 (75.0%)
20 (8.4%)
Glomerulation= 2,3, MBC < 760 mL
66 (58.4%)
47 (41.6%)
113 (47.5%)
With Hunner’s lesion
7 (53.8%)
6 (46.2%)
13 (5.5%)
Total
125 (52.5%)
113 (47.5%)
238 (100%)
P= 0.024
Table 2. Changes of symptom scores and urodynamic parameters after intravesical Botox injection in IC/BPS patients with successful treatment outcome (GRA ≥ 2) and failed treatment outcome (GRA ≤ 1)
Urodynamic parameters
Time
point
GRA ≤ 1
(n= 125)
GRA ≥ 2
(n= 113)
Total
(n=238)
ICSI
BL
FU
12.2±3.70
9.41±4.71*
12.6±3.77
4.97±3.88*#
 
ICPI
BL
FU
11.5±3.07
9.45±4.41*
12.0±3.39
4.59±4.23*#
 
OSS
BL
FU
23.7±6.39
18.9±8.56*
24.6±6.64
9.56±7.77*#
 
VAS
BL
FU
4.48±32.42
3.87±3.38
5.19±2.77
2.15±2.74*#
 
First sensation (mL)
BL
FU
112±50.5
126±67.9*
117±51.9
130±58.2*
115±51.2
128±63.2*
Full sensation (mL)
BL
FU
177±74.2
190±91.1
184±73.3
205±90.0
180±7.7
197±90.6*
Urge sensation (mL)
BL
FU
216±86.6
222±110
229±90.1
238±110
222±88.4
230±110
Detrusor pressure (cmH2O)
BL
FU
20.4±12.7
21.4±25.7
21.9±14.9
18.2±14.4*
21.1±13.8
19.9±20.9
Maximum flow rate (mL/s)
 
BL
FU
12.0±6.51
10.5±5.97
12.5±4.94
12.4±6.30
12.3±5.79
11.4±6.19
Voided volume (mL)
 
BL
FU
232±113
227±139
268±130
253±131
249±123
240±135
Post-void residual volume (mL)
BL
FU
39.4±71.3
70.4±106*
26.9±53.4
48.0±82.1*
33.2±63.3
59.3±95.2*
Cystometric bladder capacity(mL)
BL
FU
273±109
290±147
297±126
304±126
285±118
297±137
Bladder compliance
(mL/cmH2O)
BL
FU
63.4±67.0
62.7±60.0
60.0±61.8
79.7±88.5
61.7±64.4
71.1±75.7
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    2020-06-11 11:37:41
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