This is a single arm pilot study evaluating the feasibility and preliminary safety of a single intravesical instillation of TC-3 gel mixed with botulinum toxin (BTX) for symptomatic improvement in overactive bladder patients.
BTX is considered as therapeutic option for overactive bladder (OAB). Randomized placebo-controlled studies have shown that BTX administered by intramural injection into the bladder wall in patients with OAB leads to significant improvement in urodynamic parameters and quality of life. (Schurch 2008). On the other hand, the animal study suggests that intravesically applied BTX acts to decrease frequency of bladder contraction by inhibiting sensory mechanism in the urothelium rather than directly through inhibition of the smooth muscle contraction. (Khera 2005). The efficacy of intravesical BTX instillation was only tested in a few open label trials for overactive bladder patients whereby the clinical improvement observed was short-lasting with a mean duration of 6.8 weeks (Petrou 2009, Krhut 2011). The short exposure duration of the urothelium to BTX could be one of the factors responsible for the lack of a sustained effect. TC-3 is a hydrogel with reverse thermal gelation properties that when mixed with BTX and instilled intravesically serves as the drug reservoir allowing for gradual release of BTX and thereby for its extended contact with bladder urothelium.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
3
Patients will be treated with a single intravesical instillation of 40 ml TC-3 gel mixed with 300U BTX
Urology Department, Edith Wolfson Medical Center
Holon, Israel
Safety
1. Adverse events measured during entire study period. Adverse events will be graded according to the Common Toxicity Criteria on a scale of 0 to 5. 2. Presence of the urinary retention defined as a PVR \>200 ml.
Time frame: 16 weeks
Efficacy
1. Number of urinary urge episodes in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) 2. Proportion of patients who had positive treatment response per Treatment Benefit Scale (TBS) (primary endpoint - week 12 post instillation).
Time frame: 16 weeks
exploratory efficacy
1. Number of voids in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) 2. Number of urge incontinence episodes in 24-hour period per 3-day voiding diary (primary endpoint - week 12 post instillation) 3. Number of nocturnal voids per night per 3-day voiding diary (primary endpoint - week 12 post instillation). 4. Post Void Residual Volume (PVR) as measured by bladder ultrasonography (primary endpoint - week 12 post instillation) 5. KHQ score (Kings Health Questionnaire) (primary endpoint - week 12 post instillation). 6. I-QOL score (Incontinence Quality of Life questionnaire) (primary endpoint - week 12 post instillation).
Time frame: 16 weeks
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