Success of repeat detrusor injections of botulinum a toxin in patients with severe neurogenic detrusor overactivity and incontinence.
OBJECTIVE
Detrusor injections with botulinum toxin type A are an effective treatment for neurogenic detrusor overactivity, lasting for 9-12 months. When the patients develop botulinum resistance, subsequent injections might be less effective. Repeat injections in patients with severe neurogenic detrusor overactivity and incontinence were studied.


METHODS
Patients received Botox (300 UI) or Dysport (750 UI) injections. Clinical variables: satisfaction, anticholinergics use, mean and maximum bladder capacity, continence volume. Cystometric parameters: compliance, cystometric capacity, reflex volume.


METHODS
Anova, chi2-tests; t-tests and paired t-tests (p=0.05).


RESULTS
Forty-three men and 23 women (mean age 38.3 years; mean duration of lesion 9.2 years) were included. The interval between subsequent injections (on average 9-11 months) did not change significantly (p=0.5594). The satisfaction was high and anticholinergics use decreased substantially (p=0.0000). Significant improvements were found in clinical parameters and in cystometric capacity, for compliance only at the second treatment. The incidence of reflex contractions was significantly reduced. Four patients had transient adverse events after Dysport.


CONCLUSIONS
Repeat injections with botulinum toxin type A are as effective as the first one. The cause for repeat treatment is relapse of overactive bladder symptoms.
Grosse
Joachim
J
Department of Urology, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany. jgrosse@ukaachen.de
Kramer
Guus
G
Stöhrer
Manfred
M
D000109:Acetylcholine / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009122:Muscle Hypertonia / Q000188:drug therapy / Q000503:physiopathology; D009123:Muscle Hypotonia / Q000188:drug therapy / Q000503:physiopathology; D009130:Muscle, Smooth / Q000187:drug effects / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics; D014665:Vasodilator Agents / Q000627:therapeutic use
D009465:Neuromuscular Agents; D014665:Vasodilator Agents; D019274:Botulinum Toxins, Type A; D000109:Acetylcholine