This is the first study to compare the clinical effectiveness of combining
triamcinolone acetonide with onabotulinumtoxin A (Botox) versus Botox monotherapy in
the local treatment of interstitial cystitis/bladder pain syndrome (IC/BPS).

A cohort study included 52 female patients with types II and III IC/BPS,
who were managed at a tertiary hospital in KSA from January 2024 to August 2025. The
cohort was subdivided into group 1 (n=31), who received an intradetrusor injection of 40
mg triamcinolone plus 100 units of Botox, and group 2 (n=21), who received an
intradetrusor injection of Botox alone. The groups were compared using the Pelvic Pain
and Urgency/Frequency (PUF) score at baseline, 4 and 12 weeks after treatment, and
then every three months thereafter. We utilized the Statistical Package for Social
Sciences (SPSS) version 31 for data analysis.

The study groups were comparable with respect to patient demographics.
After 4 weeks post-surgery, the mean total PUF score decreased significantly from 22
preoperatively to 10.5 in group 1 and from 21.9 to 14.7 in group 2, with a statistically
significant difference between the study groups (p<0.001). Additionally, the mean total
symptom score decreased from 16.1 to 8 in group 1, and from 16 to 11.1 in group 2
(p<0.001). The mean total bother score fell from 5.9 to 2.5 in group 1, while it dropped
from 5.8 to 3.6 in group 2 (p=0.002). A favorable response to treatment was reported in
74.2% of group 1, compared with 57.1% in group 2, with a statistically significant
difference (P=0.07). For the entire cohort, PUF scores did not change after 3 months of
surgery. The median treatment efficacy duration was 38 weeks in Group 1, compared
with 37 weeks in Group 2 (P=0.82). Cystitis was reported in one patient in each group.

We presented our approach combining triamcinolone acetonide and Botox treatment for
type II & III IC/BPS, with good, durable results [1].
Botox inhibits the neurogenic inflammatory process in IC/BPS, while triamcinolone has
anti-inflammatory properties as a steroid, providing a synergistic mechanism [2-3].
Our results showed significant improvement and greater satisfaction among patients who
received the combined therapy compared with Botox monotherapy, with no differences in
complications or treatment durability (median 9 months) between the two approaches.
The synergistic effect of submucosal Botox and triamcinolone increased the favorable
treatment response and success from 57% with Botox alone to 74%.

Our study demonstrates that combining triamcinolone with Botox is superior to Botox
alone for bladder submucosal injection treatment of type II & III IC/BPS. The
combination's synergistic effect is reflected in significant symptom relief and improved
overall patient quality of life.

Mojallid A, Alzahrani M, Abdulsamad A, Alghamdi A, Alghamdi M, Alayyad A, Alotaibi A, Alamri A, Elatreisy A. 149-Clinical Efficacy of Combination of Local Triamcinolone and Botulinum Toxin A for Managing Type II/III Interstitial Cystitis/Bladder Pain Syndrom, a Single Centre Perspective.Continence. 2025 Jan 1;15:102073.
Giannantoni A, Costantini E, Di Stasi SM et al: Botulinum a toxin intravesical injections in the treatment of painful bladder syndrome: A pilot study. Eur Urol 2006; 49: 704.
Pinto R, Lopes T, Frias B et al: Trigonal injection of botulinum toxin a in patients with refractory bladder pain syndrome/interstitial cystitis. Eur Urol 2010; 58: 36