Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
Acıpayam State Hospital, Urology Clinic, Denizli, Turkey.
Low Urin Tract Symptoms. 2024 Mar;16(2):e12511. doi: 10.1111/luts.12511.
To determine the effect of intravesical onabotulinum toxin-A (BoNT-A) treatment on sexual functions in female patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS).
Female patients with IC/BPS refractory to previous treatments were included in the study between January 2020 and April 2022. Patients were treated with the trigone-sparing injection (Group 1) or trigone-included injection (Group 2) techniques. 100 Units of BoNT-A was applied submucosally on 20 different points. The patients were evaluated with visual analog scale (VAS), O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Female Sexual Function Index (FSFI) questionnaires, 3-day voiding diary, uroflowmetry, and post-voiding residual volume analysis in the preoperative period, as well as on the 30th and 90th days postoperatively. For the repeated measurements, analysis of variance was used to assess the time-dependent variation across groups.
The baseline FSFI score of the patients was 15.96 ± 3.82. Following the treatment, the FSFI scores were 22.43 ± 4.93 and 24.41 ± 5.94 on the 30th and 90th days, respectively (p < .001). We observed statistically significant improvement in all FSFI subdomains (p < .05). Statistically significant improvements with treatment on ICSI, ICPI, and VAS scores were achieved (p < .05). Preoperative FSFI scores were similar in Group 1 and Group 2 (p = .147). While the preoperative FSFI scores were 17.00 ± 3.73 and 14.84 ± 3.72 for Group 1 and Group 2, respectively, the scores after the treatment were 22.85 ± 5.01 and 21.98 ± 5.01 on the 30th day, and 24.62 ± 6.06 and 24.19 ± 6.05 on the 90th day postoperatively. Significant improvement was observed in FSFI scores with treatment, and no difference was observed between the two groups in terms of treatment response (p = .706).
Intravesical BoNT-A injection in the treatment of women with refractory IC/BPS improves sexual functions. It also significantly improves pain and symptom scores. Both trigone-sparing and trigone-including injections are similarly safe and effective.
评估膀胱内注射肉毒毒素 A（BoNT-A）对难治性间质性膀胱炎/膀胱疼痛综合征（IC/BPS）女性患者性功能的影响。
本研究纳入了 2020 年 1 月至 2022 年 4 月间接受过先前治疗但仍无效的 IC/BPS 女性患者。患者接受三角区保留注射（第 1 组）或三角区包含注射（第 2 组）治疗。将 100 个单位的 BoNT-A 黏膜下注射至 20 个不同部位。患者术前、术后 30 天和 90 天分别采用视觉模拟量表（VAS）、O'Leary-Sant 间质性膀胱炎症状指数（ICSI）、间质性膀胱炎问题指数（ICPI）、女性性功能指数（FSFI）问卷、3 天排尿日记、尿流率和剩余尿量分析进行评估。对于重复测量，采用方差分析评估组间随时间的变化。
患者术前 FSFI 评分为 15.96±3.82。治疗后第 30 天和第 90 天 FSFI 评分为 22.43±4.93 和 24.41±5.94（p<0.001）。所有 FSFI 亚域的评分均有统计学显著改善（p<0.05）。ICSI、ICPI 和 VAS 评分的治疗改善也具有统计学意义（p<0.05）。第 1 组和第 2 组术前 FSFI 评分相似（p=0.147）。治疗前第 1 组和第 2 组的 FSFI 评分为 17.00±3.73 和 14.84±3.72，治疗后第 30 天分别为 22.85±5.01 和 21.98±5.01，第 90 天分别为 24.62±6.06 和 24.19±6.05。FSFI 评分随治疗显著改善，两组治疗反应无差异（p=0.706）。
膀胱内注射 BoNT-A 治疗难治性 IC/BPS 女性患者可改善性功能，并显著改善疼痛和症状评分。三角区保留和包含注射均安全有效。
