Role of botulinum toxin-A in refractory idiopathic overactive bladder patients without detrusor overactivity.

Abstract

BACKGROUND:

To evaluate the efficacy of intradetrusor botulinum toxin-A (BTX-A) in idiopathic overactive bladder patients (OAB) refractory to anti-muscarinic therapy, without detrusor overactivity (DOA) on urodynamics.

METHODS:

Patients with refractory idiopathic OAB without DOA on urodynamics were prospectively enrolled. Subjects completed a 3-day voiding diary (3-VD), urogenital distress inventory-6 questionnaire (UDI-6) and graded their quality of life on a 10-cm visual analog scale (VAS) prior to study enrollment and at week 12 postinjection. All patients underwent multichannel urodynamics at study enrollment and 12 weeks postinjection. Improvement was analyzed based on 3-VD, UDI-6 questionnaire, VAS scores, and urodynamic parameters at week 12 postinjection compared to study enrollment.

RESULTS:

The study included 32 patients. Mean ± SD age was 56 ± 16. There were 27 women and 5 men. Nineteen patients had OAB without incontinence (OAB-dry) and 13 patients had OAB with incontinence (OAB-wet). In OAB-dry patients, mean ± SD urinary frequency dropped from 24 ± 11 to 10 ± 4 by week 12. In OAB-wet patients, mean ± SD urge incontinence episodes dropped from 7.9 ± 5 to 0 ± 2.6 by week 12. Mean UDI-6 and VAS scores improved significantly in both groups by week 12 (P = 0.0001). On comparing urodynamic parameters, OAB-wet patients showed significant decrease in maximum detrusor pressure during the voiding phase at week 12 compared to baseline values (P = 0.02).

CONCLUSIONS:

Refractory idiopathic OAB patients without DOA on urodynamics may benefit from intradetrusor BTX-A.

• Authors: Prashanth Kanagarajah, Rajinikanth Ayyathurai, Daniel J Caruso, Christopher Gomez, Angelo E Gousse
• Journal: International urology and nephrology (Int Urol Nephrol) Vol. 44 Issue 1 Pg. 91-7 (Feb 2012) ISSN: 1573-2584 [Electronic] Netherlands
• PMID: 21643644 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Muscarinic Antagonists
• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Adult
• Aged
• Botulinum Toxins, Type A (administration & dosage, therapeutic use)
• Female
• Humans
• Injections, Intramuscular
• Male
• Middle Aged
• Muscarinic Antagonists (therapeutic use)
• Muscle, Smooth (physiology)
• Neuromuscular Agents (administration & dosage, therapeutic use)
• Prospective Studies
• Quality of Life
• Statistics, Nonparametric
• Surveys and Questionnaires
• Treatment Failure
• Urinary Bladder, Overactive (complications, drug therapy, physiopathology)
• Urinary Incontinence, Urge (etiology)
• Urodynamics