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Purpose <p>Intravesical injection of botulinum toxin A (BoNT-A) has been increasingly explored as a treatment for interstitial cystitis/bladder pain syndrome (IC/BPS) refractory to conventional therapies. However, standard treatment protocol of BoNT-A for IC/BPS has not been established.</p> Recent Findings <p>BoNT-A exhibits unique neuromodulatory and anti-inflammatory effects in the bladder through the inhibition of neurotransmitter release, modulation of sensory pathways, and attenuation of urothelial apoptosis. Clinical studies consistently demonstrate short-term improvements in pain, urinary frequency, and quality of life (QoL), especially in bladder-centric or non-Hunner phenotypes. However, outcomes remain heterogeneous across trials, with uncertainties regarding optimal dosing, injection sites, patient selection, and long-term efficacy. Adverse events, including urinary tract infection and voiding dysfunction, also limit widespread adoption.</p> Summary <p>This review synthesizes current evidence on the mechanistic rationale, clinical effectiveness, and safety profile of BoNT-A in IC/BPS, highlights phenotype-specific responses, and discusses integration with emerging therapies such as platelet-rich plasma and neuromodulation.</p>

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From Toxin To Therapy: Advances and Challenges of Botulinum Toxin A in the Treatment of Interstitial Cystitis/Bladder Pain Syndrome Over the Past Decades

  • 期刊论文

  • 发表日期：

    2025年12月29日

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  • Wan-Ru Yu,
  • Hann-Chorng Kuo

摘要

Purpose

Intravesical injection of botulinum toxin A (BoNT-A) has been increasingly explored as a treatment for interstitial cystitis/bladder pain syndrome (IC/BPS) refractory to conventional therapies. However, standard treatment protocol of BoNT-A for IC/BPS has not been established.

Recent Findings

BoNT-A exhibits unique neuromodulatory and anti-inflammatory effects in the bladder through the inhibition of neurotransmitter release, modulation of sensory pathways, and attenuation of urothelial apoptosis. Clinical studies consistently demonstrate short-term improvements in pain, urinary frequency, and quality of life (QoL), especially in bladder-centric or non-Hunner phenotypes. However, outcomes remain heterogeneous across trials, with uncertainties regarding optimal dosing, injection sites, patient selection, and long-term efficacy. Adverse events, including urinary tract infection and voiding dysfunction, also limit widespread adoption.

Summary

This review synthesizes current evidence on the mechanistic rationale, clinical effectiveness, and safety profile of BoNT-A in IC/BPS, highlights phenotype-specific responses, and discusses integration with emerging therapies such as platelet-rich plasma and neuromodulation.