Use of botulinum-A toxin for the treatment of refractory overactive bladder symptoms: an initial experience.
OBJECTIVE
To define the role of botulinum toxin type A (botulinum-A) intradetrusor injections in the treatment of patients with symptoms of bladder overactivity in whom previous anticholinergic therapy has failed.


METHODS
Thirty-five patients (29 women and 6 men) with frequency, urgency, and/or urge incontinence received 300 U of botulinum-A toxin injected transurethrally at 30 sites within the bladder. Patients were evaluated at 3 weeks and 6 months after treatment by completion of the short forms of the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6), as well as questions assessing global response to the treatment.


RESULTS
After 3 weeks, the mean IIQ-7 score decreased from 19.4 to 13.9 (P = 0.0006) and the mean UDI-6 score decreased from 16.8 to 12.8 (P = 0.0003). Overall, 21 (60%) of 35 patients reported slight to complete improvement of voiding symptoms after 3 weeks. Among the initial responders followed up for 6 months, the mean IIQ-7 score improved from 20.6 to 15.1 (P = 0.008) and the mean UDI-6 score improved from 16.9 to 13.5 (P = 0.008). Mild hematuria, pelvic pain, and dysuria were seen in 7 patients, lasting for 3 days or less after the procedure.


CONCLUSIONS
Botulinum-A toxin injections may provide improvement in symptoms associated with bladder overactivity in a subset of patients. Improvement may be seen for at least 6 months after treatment. The procedure was well tolerated with minimal side effects. Additional study to define the role of injections in a broad group of patients with irritative voiding symptoms is warranted.
Rapp
David E
DE
Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Lucioni
Alvaro
A
Katz
Erin E
EE
O'Connor
R Corey
RC
Gerber
Glenn S
GS
Bales
Gregory T
GT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000209:etiology
D019274:Botulinum Toxins, Type A