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

1
Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, 53100 Siena, Italy
2
Department of Urology, San Donato Hospital, 52100 Arezzo, Italy
3
Serafico Institute of Assisi, Research centre “InVita”, Assisi, 06081 Perugia, Italy
4
Department of Medicine, University of Perugia, 06123 Perugia, Italy
*
Author to whom correspondence should be addressed.
Toxins 2019, 11(9), 510; https://doi.org/10.3390/toxins11090510
Received: 26 July 2019 / Revised: 21 August 2019 / Accepted: 28 August 2019 / Published: 30 August 2019
(This article belongs to the Special Issue Botulinum Toxin for Neuropathic Pain Treatment)
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 = –0.302; p = 0.007 and –0.430, p = 0.004, respectively); Visual Analog Scale (VAS) for pain and day-time urinary frequency (medium effect size: SMD = –0.576, p < 0.0001 and –0.546, p = 0.013, respectively). A great effect size was detected for post-void residual volume (PVR, SMD = 0.728; p =0.002) although no clinically relevant in most cases. Great heterogeneity was observed in treatments’ methodologies and symptoms assessment. Overall, BoNT/A intravesical injections significantly improve some of the most relevant symptoms affecting IC/BPS patients. View Full-Text
Keywords: interstitial cystitis; bladder painful syndrome; chronic pelvic pain; neuropathic pain; botulinum neurotoxin A; onabotulinumtoxinA; abobotulinumtoxin A; intravesical injection interstitial cystitis; bladder painful syndrome; chronic pelvic pain; neuropathic pain; botulinum neurotoxin A; onabotulinumtoxinA; abobotulinumtoxin A; intravesical injection
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Giannantoni, A.; Gubbiotti, M.; Bini, V. Botulinum Neurotoxin A Intravesical Injections in Interstitial Cystitis/Bladder Painful Syndrome: A Systematic Review with Meta-Analysis. Toxins 2019, 11, 510.

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