Urolieve (lidocaine alkalized intravesicular) / Regent Pacific Group - LARVOL DELTA

COMPARATIVE ASSESSMENT OF TWO STANDARD OF CARE PAIN MANAGEMENT PROTOCOLS FOR INTRADETRUSOR ONABOTULINUMTOXINA INJECTIONS IN A DIVERSE URBAN PATIENT POPULATION (AUA 2026) - "Source of Funding: None INTRODUCTION AND OBJECTIVES: Intravesical alkalinized lidocaine instillation prior to intradetrusor onabotulinumtoxinA (BTX-A) injection for refractory overactive bladder (OAB) may be undesirable to some patients due to prolonged appointment time and associated discomfort. Oral phenazopyridine represents a feasible alternative for periprocedural pain control prior to intravesical onabotulinumtoxinA injections when patients prefer a less invasive or quicker option. These findings highlight an important opportunity for shared decision-making and operational efficiency in the outpatient procedure setting."

Clinical • Overactive Bladder • Pain

A Randomized, Placebo-controlled Trial of Nitrous Oxide During In-office Bladder Botox Injections (clinicaltrials.gov) - P4 | N=96 | Not yet recruiting | Sponsor: TriHealth Inc.

New P4 trial • Overactive Bladder • Pain • Urinary Incontinence • Urology • Women's Health

Evaluation of lidocaine as a dual-route prophylaxis in postoperative catheter-related bladder discomfort: a comprehensive systematic review and meta-analysis with trial sequential analysis and GRADE evaluation. (PubMed, Naunyn Schmiedebergs Arch Pharmacol) - "This study aims to systematically evaluate (1) the efficacy of intravenous (IV) lidocaine compared with normal saline, (2) the efficacy of intravesical lidocaine compared with normal saline, and (3) postoperative outcomes including opioid requirements, as specified in the PROSPERO registration (CRD420251155678)...Both IV and transurethral lidocaine significantly reduce early postoperative CRBD. Lidocaine represents a safe, effective, and easily applicable option for short-term prevention of CRBD."

Journal • Retrospective data • Review • Pain

Flexi-comfort: Enhancing Patient Comfort and Reducing Anxiety During Flexible Cystoscopy and Bladder Instillation in Bladder Cancer Patients: A Randomized Controlled Trial and Observational Study (clinicaltrials.gov) - P=N/A | N=378 | Not yet recruiting | Sponsor: Western University, Canada

New trial • Bladder Cancer • Genito-urinary Cancer • Oncology • Psychiatry • Solid Tumor

Prevention of catheter-related bladder discomfort and agitation by intravesical lidocaine administration during awake craniotomy: a retrospective study. (PubMed, J Anesth) - No abstract available

Journal • Retrospective data

Prophylactic Analgesia for Bladder Botox Injections (clinicaltrials.gov) - P4 | N=0 | Withdrawn | Sponsor: Montefiore Medical Center | N=120 ➔ 0 | Not yet recruiting ➔ Withdrawn

Enrollment change • Trial withdrawal • Overactive Bladder • Pain • Urinary Incontinence • Urology

Integrated assessment of continuous uroflow cystometry and visceromotor responses to bladder distension in urethane-anesthetized mice. (PubMed, J Pharmacol Exp Ther) - "Mice were first anesthetized with 1.75% isoflurane inhalation for the surgical implantation of a bladder catheter and stainless-steel wire electrodes to the external oblique musculature for delivering bladder distension and recording muscular response respectively...Intravesical infusion of acetic acid significantly enhanced the VMR to grader bladder distension and disrupted the regular micturition cycles, which were normalized by intravesical lidocaine...SIGNIFICANCE STATEMENT: A urethane anesthesia protocol was optimized for robust cystometrogram and visceromotor response recordings in mature and aged mice. This model allows assessment of bladder physiology and pain, demonstrating that acetic acid disrupts micturition and enhances pain responses, which lidocaine normalizes."

Journal • Preclinical • Anesthesia • Gynecology • Musculoskeletal Pain • Overactive Bladder • Pain

A Novel Technique for Intravesical Anesthesia During Intravesical Botox Administration (AUA 2025) - "Intradetrusor lidocaine injection prior to Botox administration enhances patient comfort and optimizes procedural efficiency, representing an advancement in intravesical therapy. This procedure eliminates the need for straight catheterization and instillation of 30-40 mL of intravesical lidocaine with a 20-30 minute dwell time in the bladder. Eliminating dwell time and straight catheterization to achieve local anesthesia significantly reduces the procedure time and cost."

Anesthesia • Pain

Understanding the current evidence base for the commonly recommended management strategies for recurrent feline idiopathic cystitis: a systematic review. (PubMed, N Z Vet J) - "Studies were categorised according to one of seven management strategies: environmental modification, dietary manipulation, anti-inflammatory drugs, amitriptyline, glycosaminoglycans, prazosin, and intravesical lidocaine. The evidence for other modalities, is currently insufficient to support their use. The overall lack of high quality studies emphasises the need for clinicians to be critical in their evaluation of the published literature on the management of this perplexing condition."

Journal • Review

Lidocaine solution vs. lidocaine gel instillation for pain management during intravesical botulinum injections. (PubMed, Can Urol Assoc J) - "Lidocaine gel alone may be an acceptable analgesic alternative while improving availability and efficiency of treatment delivery. Our findings are limited by the retrospective nature of the study and the small sample size."

Journal • Overactive Bladder • Pain • Urology

Alkalinised lidocaine as an anaesthetic before onabotulinumtoxinA injections. a randomised trial. (PubMed, BJU Int) - P3 | "Intravesical instillation of alkalinised lidocaine before BTX-A injections significantly reduced VAS pain scores compared to placebo (ClinicalTrials.gov identifier: NCT05415865)."

Journal • Aesthetic Medicine • Anesthesia • Gynecology • Infectious Disease • Nephrology • Overactive Bladder • Pain

Optimal Intravesical Lidocaine Volume for Pain Relief During Office Intra-detrusor Onabotulinum Toxin a Injections (clinicaltrials.gov) - P4 | N=36 | Not yet recruiting | Sponsor: University of Louisville

Head-to-Head • New P4 trial • Overactive Bladder • Pain • Urinary Incontinence

Letter: Cost Analysis of Oral Phenazopyridine vs Intravesical Lidocaine for Preprocedural Analgesia for Intradetrusor OnabotulinumtoxinA Injections. (PubMed, Urol Pract) - No abstract available

Cost-analysis • HEOR • Journal

Efficacy Of Intravesical Alkalinized Lidocaine Solution Prior to Cystoscopy: A Prospective, Single Centre, Randomized, Double-Blind, Parallel Group Trial. (UAA 2024) - No abstract available

Clinical

Prophylactic Analgesia for Bladder Botox Injections (clinicaltrials.gov) - P4 | N=120 | Not yet recruiting | Sponsor: Montefiore Medical Center

New P4 trial • Overactive Bladder • Pain • Urinary Incontinence • Urology

Cost Analysis of Oral Phenazopyridine vs Intravesical Lidocaine for Preprocedural Analgesia for Intradetrusor OnabotulinumtoxinA Injections. (PubMed, Urol Pract) - "Phenazopyridine provides cost savings compared to lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. If adopted by providers nationwide, phenazopyridine may reduce health care spending and minimize office visit time while maintaining patient pain control and satisfaction."

Cost-analysis • HEOR • Journal • Overactive Bladder • Pain

COST ANALYSIS OF ORAL PHENAZOPYRIDINE VERSUS INTRAVESICAL LIDOCAINE FOR PRE- PROCEDURAL ANALGESIA FOR INTRADETRUSOR ONABOTULINUMTOXINA INJECTIONS (AUA 2024) - "PYR provides significant cost savings compared to LID for analgesia during intradetrusor BTX injections for refractory idiopathic OAB. If adopted by providers nationwide, this could reduce healthcare spending and minimize time-consuming office visits while maintaining patient pain control and satisfaction."

Cost-analysis • HEOR • Overactive Bladder • Pain

Investigation of agitation during awake craniotomy, and the relationship between the effect of catheter-related bladder discomfort (CRBD) and the preventive effect of lidocaine (Euroanaesthesia 2024) - "Intravesical lidocaine significantly reduced the frequency of CRBD in male patients (P=0.03) ,but did not significantly reduce agitation events. Conclusion(s): In AC, moderate or higher CRBD was associated with agitation.And intraurethral lidocaine administration was also effective for CRBD in men while awake phase."

Anesthesia • Pain

Assessment of symptomatic response to intravesical alkalinized lidocaine, bupivacaine, heparin and steroids in patients with bladder pain syndrome. (PubMed, Trop Doct) - "Evaluating the benefits of this therapy, patients experienced 82.2% & 90.9% relief at 3rd & 6th week of instillation. After completion of six cycles of therapy, patients experienced 68.7% & 65.3% relief at 3rd & 6th month follow up, concluding the early and long term relief of BPS."

Journal • Interstitial Cystitis • Musculoskeletal Pain • Pain

A urethane anesthesia protocol for robust recordings of bladder cystometrogram and visceromotor responses to bladder distention in mice (Neuroscience 2023) - "Intravesical acetic acid significantly enhanced the VMR to UBD and disrupted the regular micturition cycles in CMG, which were normalized by intravesical lidocaine. This new anesthesia protocol will enable focused studies to advance our mechanistic understanding of bladder-related disorders."

Preclinical • CNS Disorders • Musculoskeletal Pain • Pain

Does large volume of distribution of lidocaine masks its systemic uptake from bladder? (PubMed, Am J Clin Exp Urol) - "Whether rapid absorption of instilled lidocaine is complicated by an equally rapid and extensive dilution in body weight dependent Vd can be resolved by early blood sampling (<30 min) for: evidence-based medicine, avoidance of lidocaine toxicity in children and to educate the evolution of lidocaine solution to gel and devices."

Journal • Bladder Cancer • CNS Disorders • Genito-urinary Cancer • Hypotension • Oncology • Pain • Solid Tumor • Urothelial Cancer

The experiment for anti-tumor effect of lidocaine and the impact of intravesicle lidocaine administration in bladder cancer: Developing clinical model based on the translational research (Euroanaesthesia 2023) - "And the clinical dose of lidocaine demonstrated anti-tumor effects on 253 J cell-derived bladder cancer in nude mice. Accordingly, we may expect that the clinical benefit of the intravesical lidocaine administration as an alternative adjuvant therapy in patients with a transurethral resection of bladder tumor."

Clinical • Anesthesia • Bladder Cancer • Genito-urinary Cancer • Oncology • Solid Tumor • Urothelial Cancer

Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: A systematic review. (PubMed, Neurourol Urodyn) - "EMDA of intravesical alkalinized lidocaine, intravesical, alkalinized lidocaine without EMDA, and a reduction in the number of injection site were all associated with improvements in patient tolerability during LA BTA injections. Further research should address which subgroups of patients find the procedure most painful and would benefit most from these interventions."

Journal • Review • Anesthesia • Overactive Bladder • Pain

The Effect of Local Anesthetic Solution in the Bladder Prior to Botox Injections in the Bladder (clinicaltrials.gov) - P3 | N=50 | Recruiting | Sponsor: Herlev and Gentofte Hospital | Not yet recruiting ➔ Recruiting

Enrollment open • Anesthesia • Infectious Disease • Nephrology • Overactive Bladder • Pain • Urinary Incontinence

Intravesical sustained release system of lidocaine and oxybutynin results from in vitro and animal study. (PubMed, Int Urol Nephrol) - "The in-vitro and animal data demonstrated that TRG-042 can safely be used for intravesical sustained release of lidocaine and oxybutynin in the treatment of BPS/IC."

Journal • Preclinical • Interstitial Cystitis • Musculoskeletal Pain • Pain