Guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management: Translation of French recommendations.

Abstract

OBJECTIVE:

Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management.

PATIENTS AND METHODS:

Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts.

RESULTS:

In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1 mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200 mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection.

CONCLUSIONS:

Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio.

• Authors: J-F Hermieu, P Ballanger, G Amarenco, É Chartier-Kastler, M Cosson, P Costa, B Fatton, C Saussine, P Denys, X Gamé, F Haab, G Karsenty, L Le Normand, A Ruffion, X Deffieux
• Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie (Prog Urol) Vol. 24 Issue 11 Pg. e1-7 (Sep 2014) ISSN: 1166-7087 [Print] France
• PMID: 25214455 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Botulinum Toxins, Type A (therapeutic use)
• Humans
• Neuromuscular Agents
• Practice Guidelines as Topic
• Urinary Bladder, Overactive (drug therapy)