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Lorenzo L, Bonillo MA, Arlandis S, Martínez-Cuenca E, Marzullo L, Broseta E, Boronat F. Hydrodistension plus Onabotulinumtoxin A in bladder pain syndrome refractory to conservative treatments. [Article in English, Spanish] Actas Urol Esp. 2016 Feb 11. pii: S0210-4806(16)00006-1. doi: 10.1016/j.acuro.2015.12.011. [Epub ahead of print]

The use of hydrodistention plus botulinum toxin has been studied by multiple research groups. Injections of botulinum toxin are thus listed as a fourth-line treatment option in American Urological Association guidelines for interstitial cystitis/bladder pain syndrome (IC/BPS) and are discussed in European guidelines as well. Accordingly, this group of researchers in Spain set out to describe their own experience in implementing this technique in 25 patients with BPS that did not respond to conventional treatment. The study included 25 patients who underwent hydrodistention plus botulinum toxin injection at least once (13 of the patients had reoperations). Subjective improvements were noted in 84% of the subjects, meaning that only 4 patients (16%) did not improve. Moreover, treatment reduced pain and voiding frequency to a significant degree. The improvement lasted for an average of 7 months, and complications, which were mild, occurred in about one-quarter of the patients. Based on their experience, the investigators concluded that hydrodistention plus botulinum toxin injection is a useful therapeutic option for patients who don’t respond to more standard treatments.