[Prospective study of the clinical and urodynamic results of intradetrusor botulinum toxin injections for the treatment of neurogenic overactive bladder].

Abstract

OBJECTIVE:

To evaluate the clinical and urodynamic efficacy and duration of efficacy of intradetrusor botulinum toxin A (BTA) injections in patients with neurogenic overactive bladder refractory to anticholinergic therapy.

PATIENTS AND METHODS:

Between 2004 and 2005, 33 patients (19 men and 14 women), with neurogenic overactive bladder were treated by intradetrusor injections of 300 U of BTA (Botox) in 30 points. All patients were refractory to, intolerant of or presented contraindications to anticholinergic therapy. All patients voided by intermittent self-catheterization.

RESULTS:

Six weeks after BTA injections, the success rate was 75.8%, with improvement in 12.1% of cases and failure in 9.1% of cases. The mean number of self-catheterizations per 24 h was significantly decreased (6.37 versus 5.2, P=0.02), the maximum voiding volume was increased (321.68 ml versus 536.25 ml, P=0.002), the mean number of episodes of incontinence per 24 h was decreased (7.39 versus 0.03, P<0.0001), the proportion of patients with incontinence was decreased (66.66% versus 6.04%, P<0.0001), the mean maximum cystomanometric capacity was increased (286.75 ml versus 554.16 ml, P=0.002) and the mean maximum intravesical pressure was decreased (54.8 cm H(2)O versus 5.3 cm H(2)O, P<0.0001). After BTA injections, 87.8 % of patients no longer experienced uninhibited contractions. The median duration of clinical efficacy was 7.03 months. At 12 months, injections were still effective clinically in 21.2 % of patients.

CONCLUSION:

Intradetrusor BTA injections are an effective and well tolerated treatment for neurogenic overactive bladder. Their clinical efficacy persisted for more than 12 months in more than 20% of cases.

• Authors: Y Bentaleb, E Castel-Lacanal, F Sallusto, X De Boissezon, B Malavaud, P Marque, P Rischmann, X Gamé
• Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie (Prog Urol) Vol. 18 Issue 7 Pg. 449-55 (Jul 2008) ISSN: 1166-7087 [Print] France
• Vernacular Title: Etude prospective des résultats cliniques et urodynamiques des injections intradétrusoriennes de toxine botulique dans le traitement de l'hyperactivité détrusorienne neurogène.
• PMID: 18602606 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Adult
• Botulinum Toxins, Type A (administration & dosage)
• Female
• Follow-Up Studies
• Humans
• Injections, Intramuscular
• Male
• Middle Aged
• Neuromuscular Agents (administration & dosage)
• Prospective Studies
• Time Factors
• Urinary Bladder, Neurogenic (drug therapy)
• Urinary Bladder, Overactive (drug therapy)