Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan.
Toxins (Basel). 2023 Feb 2;15(2):121. doi: 10.3390/toxins15020121.
Intravesical injection of Botulinum toxin A (BoNT-A) and platelet-rich plasma (PRP) have been reported to alleviate bladder pain and decrease nocturia in patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS). Both treatments are novel and there has no comparison between them. This study compared the therapeutic effects and adverse events between IC/BPS patients receiving PRP or BoNT-A injections.
This study retrospectively analyzed female patients with IC/BPS who were refractory to conventional treatment and received BoNT-A ( = 26) or PRP ( = 30) injections within the previous two years. Patients were arbitrarily treated with four monthly injections of PRP or a single injection of 100 U of BoNT-A. All injections were followed by cystoscopic hydrodistention. The primary endpoint was the global response assessment (GRA), and secondary endpoints were changes in the O'Leary-Sant IC symptom score, visual analog score (VAS) of bladder pain, voiding diary, and uroflow measures from baseline to six months after the first injection day.
The baseline demographics revealed no significant difference between groups. The GRA at one, three, and six months was similar between groups. A significant improvement in IC symptom scores was noted in both groups. Although VAS was significantly improved in overall patients, no significant difference was noted between the PRP and BoNT-A groups at 6 months. Only half of the study cohort had a GRA ≥2 at six months. An increase in the post-void residual was noted one month after the BoNT-A injection, but there was no difference between groups at three and six months. More patients reported dysuria (19.2% vs. 3.3%, = 0.086) and urinary tract infection (UTI, 15.4% vs. 0%, = 0.041) after BoNT-A injection than after the PRP injections. The time from the first injection to receiving alternative treatment was similar between groups.
Both intravesical PRP and BoNT-A injections have similar efficacy in IC symptom improvement. However, only half of the study cohort had a GRA of ≥2 at the six-month follow-up BoNT-A injection carries a potential risk of UTI after treatment.
已有报道称，膀胱内注射肉毒毒素 A（BoNT-A）和富含血小板的血浆（PRP）可缓解膀胱疼痛并减少难治性间质性膀胱炎/膀胱疼痛综合征（IC/BPS）患者的夜尿症。这两种治疗方法均为新方法，且目前尚无两者之间的比较。本研究比较了接受 PRP 或 BoNT-A 注射的 IC/BPS 患者的治疗效果和不良反应。
本研究回顾性分析了过去两年内接受 BoNT-A（n = 26）或 PRP（n = 30）注射治疗的常规治疗无效的女性 IC/BPS 患者。患者任意接受四次每月 PRP 注射或单次 100 U BoNT-A 注射。所有注射后均行膀胱镜下液压扩张。主要终点为总体反应评估（GRA），次要终点为 O'Leary-Sant IC 症状评分、膀胱疼痛视觉模拟评分（VAS）、排尿日记和尿流率测量值从首次注射日起 6 个月的变化。
基线人口统计学数据显示两组间无显著差异。两组的 GRA 在 1、3 和 6 个月时相似。两组的 IC 症状评分均显著改善。尽管总体患者的 VAS 显著改善，但 6 个月时 PRP 和 BoNT-A 组之间无显著差异。仅半数研究队列在 6 个月时的 GRA≥2。BoNT-A 注射后 1 个月时出现残余尿量增加，但 3 和 6 个月时两组间无差异。BoNT-A 注射后更患者报告有尿痛（19.2%比 3.3%，= 0.086）和尿路感染（UTI，15.4%比 0%，= 0.041）。两组从首次注射到接受替代治疗的时间相似。
膀胱内 PRP 和 BoNT-A 注射在改善 IC 症状方面均具有相似的疗效。然而，仅有半数研究队列在 6 个月时的 BoNT-A 注射后 GRA≥2。BoNT-A 注射后有发生 UTI 的潜在风险。
