膀胱內肉毒桿菌素注射治療間質性膀胱炎/膀胱疼痛症候群之效果
－膀胱體與膀胱三角區注射之比較
李宇坤、李政霖、郭漢崇
花蓮慈濟醫院 泌尿部
Comparative study of intravesical Botox injection for interstitial cystitis/bladder pain syndrome – bladder body versus trigonal injection
Yu Khun Lee, Cheng-ling Lee, Hann-Chorng Kuo
Department of Urology, Hualien Tzu Chi Hospital, Huelien, Taiwan
Purpose: Intravesical onabotulinumtoxinA (BoNT-A) injection can relieve the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). The therapeutic efficacy of different injection sites is not well known. In this study, we compared the therapeutic efficacy and the changes of urodynamic study between bladder body and trigonal BoNT-A injection.
Materials and Methods: We conducted a prospective randomized clinical trial of bladder body versus trigonal BoNT-A injection for patients with refractory IC/BPS. Under sedation, 100U of BoNT-A in 10ml saline were injected in 20 bladder body sites or 10 trigonal sites. We evaluated the patients at 4th week and 8th week after the injection. The primary endpoint of this study was the changes of Visual Analog Scale for Pain, at the 8th week after the injection. Secondary endpoint included the changes of Global Response Assessment (GRA), urinary frequency, O'Leary-Sant score and Problem Index (ICSI, ICPI, OSS), quality of life (QoL), and urodynamic study at the 8th week after the injection.
Results: Twenty patients (Bladder body, N=10; Trigone, N=10) with refractory IC/BPS was included in this study. Patients in both group had significant improvement in VAS, ICSI, ICPI, OSS and FBC (functional bladder capacity) after the injection. The changes of ICSI (9.5±4.7 vs 5.7±4.3, p= 0.043) and OSS (18.6±8.6 vs 11.3±5.9, p= 0.047) at 8th week after the injection had significant difference between two groups, which trigonal injection had more improvement. There was no significant difference in the changed of urinary frequency (day/night), voiding volume, post-void residual urine volume (PVR) and cystometric bladder capacity (CBC) from baseline to second month after BoNT-A injection at either bladder body or trigone (table 1). Seventy percent (N=7) patients in bladder body group and 50% (N=5) patients in trigone group decreased VAS more than 2 points after the injection. Twenty percent (N=2) patients who received bladder body injection and 40% (N=4) patients who received trigonal injection had excellent improvement of the symptoms (GRA≥2) (table 2). The adverse effects were no significant difference between two groups (table 3). However, there was more patients experience dysuria after the treatment in bladder body group.
Conclusions: Bladder body and trigonal BoNT-A injection had similar therapeutic effect and adverse effects on relieving IC/BPS symptoms.