Botulinum Toxin for Neurogenic and Non-neurogenic Bladder Pain
Current Bladder Dysfunction Reports
Purpose of Review
The use of botulinum toxin in managing urinary incontinence has been well established. Given the expanding indications for this agent for several neuromuscular disorders, its role in managing the symptoms associated with interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic pelvic pain syndrome (CPPS) is evolving. In this review article, we examine the current literature on outcomes after botulinum toxin injection in patients with these conditions, as well as recent developments in mechanism of delivery.
The change in pain scores after injection in IC/BPS patients is inconsistent, as it has been used in combination with and without other interventions, such as hydrodistension. Pooled studies favor the use of botulinum toxin, but the findings are not significant to justify its use as a first-line treatment for IC/BPS. The initial hope that botulinum toxin would improve CPPS by addressing hypertonic pelvic floor dysfunction has been tempered by several studies showing no significant reduction in pain scores after injection compared to placebo.
Several studies have shown there to be a therapeutic benefit for pain management in IC/BPS, particularly in those without Hunner’s lesions. Meta-analysis suggests that higher dose may further improve pain scores, but side effects of urinary retention may limit its applicability. This effect does not appear to be dependent on how the toxin is injected (trigone vs non-trigone). Future use of intravesical liposomes to deliver botulinum toxin shows promise in administration of the agent in a non-invasive manner.
Roberts, L.H., Gilleran, J.P. Botulinum toxin for neurogenic and non-neurogenic bladder pain. Curr Bladder Dysfunct 2022 March ; 17, 38–47. https://doi.org/10.1007/s11884-021-00640-5