Triamcinolone acetonide is a glucocorticoid anti-inflammatory drug; the present study aims to assess the effectiveness of urinary bladder submucosal injection of triamcinolone acetonide and botulinum toxin A for treating type II/III interstitial cystitis/bladder pain syndrome.

This prospective study included female patients with interstitial cystitis/bladder pain syndrome (IC/BPS), types II and III, at King Fahd Armed Forces Hospital in Jeddah, Saudi Arabia, from February 2023 to September 2024. Under general anesthesia, 10 ml of triamcinolone acetonide (40 mg/ml) was injected in 0.5 ml aliquots into the urinary bladder submucosa, alongside 100 units of botulinum toxin A (BoNT-A) injected into the bladder wall. Patient symptoms and quality of life were assessed using the Pelvic Pain and Urgency/Frequency (PUF) scale before the procedure and four weeks after treatment. Patient satisfaction was evaluated utilizing a defined scoring system, which categorized improvement levels as follows: high or greater than 80% improvement (highly satisfied), intermediate at 40% to 79% improvement (intermediate satisfaction), and poor at 0% to 39% improvement.

A cohort of twenty-eight female patients diagnosed with interstitial cystitis/bladder pain syndrome (IC/BPS) type II and III underwent an endoscopic submucosal injection of triamcinolone and botulinum toxin A (BoNT-A). The mean total PUF scores significantly reduced from 22.1 preoperatively to 10.8 postoperatively (p<0.001). Additionally, the mean total symptom score decreased from 16.2 to 8.2 (p<0.001), while the mean total bother score fell from 5.9 to 2.6, with a statistically significant difference noted (p<0.001). A favorable response to treatment was reported by 20 out of 28 patients, equating to 71.4%. Notably, no perioperative complications were observed. The median duration of efficacy for the submucosal administration of triamcinolone and botulinum toxin A was recorded at 9 months.

In our clinical practice, a substantial number of patients diagnosed with IC/BPS do not achieve adequate symptom control through conventional interventions. 
•A noteworthy subset of these patients is characterized by the presence of Hunner’s ulcers, with pain being the most distressing symptom. 
•The efficacy of submucosal triamcinolone and Botox administration typically persists for at least six months. We reported a sustained response regarding symptom relief, extending to one year for most patients.

Our experience in managing IC/BPS patients: type II & III through submucosal injection of triamcinolone, in conjunction with bladder wall injection of Botox, illustrates an innovative therapeutic approach for a condition that often demonstrates resistance to conventional medical treatments for nonulcerative IC. This intervention is well tolerated and yields clinically and statistically significant improvements in symptoms and overall quality of life for a selected cohort of IC/BPS patients.