Platinum Priority – Pelvic Pain Editorial by George A. Barbalias on pp. 366–368 of this issue Trigonal Injection of Botulinum Toxin A in Patients with Refractory Bladder Pain Syndrome/Interstitial Cystitis Rui Pinto a,b , Tiago Lopes a , Ba ´rbara Frias b,c , Andre ´ Silva a,b , Joa ˜o Alturas Silva a,b , Carlos Martins Silva a,b,c , Ce ´lia Cruz b,c , Francisco Cruz a,b,c, *, Paulo Dinis a,b,c a Department of Urology, Hospital de Sa˜o Joa˜o, Portugal b Faculty of Medicine, University of Porto, Portugal c Institute of Histology and Embryology (Faculty of Medicine of Porto) and Instituto de Biologia Molecular e Celular, University of Porto, Portugal EUROPEAN UROLOGY 58 (2010) 360–365 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted February 23, 2010 Published online ahead of print on March 6, 2010 Keywords: Bladder pain syndrome Interstitial cystitis Botulinum toxin NGF BDNF Bladder trigone Pain Abstract Background: Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic dis- ease without an effective treatment, characterized by pain during bladder filling. Most nociceptive bladder afferents course in the trigone. Objective: To evaluate efficacy and tolerability of trigonal injection of botulinum toxin A (BoNTA) in patients with BPS/IC. Urine concentration of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were also evaluated. Design, setting, and participants: Women with refractory BPS/IC were included in an open, exploratory study. Intervention: Under sedation, 100 U of BoNTA (Botox) were injected in 10 trigonal sites (10 U per 1 ml saline). Retreatment was allowed 3 mo after injection. Measurements: Pain, urinary frequency, O’Leary-Sant score (OSS), quality of life, (QoL), and urodynamic testing at 1 and 3 mo and every 3 mo thereafter. Urine NGF and BDNF were assessed at the same points. Patients who were retreated were evaluated every 3 mo. Results and limitations: All patients reported subjective improvement at 1- and 3-mo follow-up. Pain, daytime and nighttime voiding frequency, OSS, and QoL improved significantly. Bladder volume to first pain and maximal cystometric capacity more than doubled. Treatment remained effective in >50% of the patients for 9 mo. Retreatment was also effective in all cases, with similar duration. A significant, transient reduction in urinary NGF and BDNF was observed. No cases of voiding dysfunction occurred. The low number of patients and the lack of a placebo arm are obvious limitations of this study. Conclusions: Trigonal injection of BoNTA is a safe and effective treatment for refractory BPS/IC. # 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Hospital S. Joao, Faculty of Medicine of Porto and IBMC of Porto, Porto, Portugal. Fax: +351 225513655. E-mail address: cruzfjmr@med.up.pt (F. Cruz). 0302-2838/$ – see back matter # 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2010.02.031