Another use for Intravesical Botox? Treatment of Interstitial Cystitis
Treating Interstitial Cystitis/Painful bladder syndrome (IC) poses a challenge to all practitioners. What works for some might not work for others. IC is characterized by urinary frequency, urinary urgency, nocturia combined with bladder and pelvic pain. The different causes of IC (i.e. allergy, genetics, injury from recurrent infection, etc.) may account for the variability in treatment response. Treatments include dietary modifications and physical therapy, oral agents like Elmiron and amitriptyline, intravesical injections, and bladder hydrodistention in the operating room.
Given the urinary frequency component of IC, I have often wondered if treating it as a terrible case of overactive bladder (OAB) would work. I have prescribed OAB medications for my IC patients in the past with disappointing results. My usual go-to treatment for IC has been DMSO bladder instillations or bladder cocktails. Still, those tend to fall short for me. I want a cure! I want complete relief for my patients.
Recently, I tried intravesical botox injections in two patients (under sedation in the OR…most IC patients won’t let you near their bladder with a cystoscope while they are awake!) and both patients had significant relief of their symptoms.
I happened to be looking through some articles recently in the International Urogynecology Journal and found a meta-analysis looking at this very topic. The authors reviewed sixteen trials totaling 905 patients. They concluded that Botox had “the highest probability of being the best treatment course” compared to all other treatment options. They found Botox significantly improved bladder capacity.
Of course, we need more studies, but this article and my two patient’s positive responses to Botox sure give hope that this may be the treatment of choice in the future for Interstitial Cystitis.
Zhang, W., et al., Intravesical treatment for interstitial cystitis/painful bladder syndrome: a network meta-analysis. Int Urogynecol J, 2017. 28(4): p. 515-525.