Intradetrusor injection of botulinum-A toxin in patients with idiopathic and neurogenic detrusor overactivity: urodynamic outcome and patient satisfaction.
OBJECTIVE
To assess and compare the efficacy of botulinum-A toxin (BTX-A) injections into the detrusor in idiopathic and neurogenic detrusor overactivity (IDO and NDO) resistant to anticholinergic treatment with respect to patient satisfaction.


METHODS
In a prospective study, 16 patients with IDO and 14 with NDO resistant to anticholinergic treatment were injected with 500 U of Dysport into the detrusor. Clinical, urodynamic, and satisfaction assessments were performed at baseline and after BTX-A injections.


RESULTS
In IDO as well as in NDO, there was a significant increase in median maximum cystometric capacity (MCC) from 177.5 to 262.5 ml (P<0.0005) and 160 to 270 ml (P=0.001), median bladder compliance from 24.5 to 40.0 ml/cmH2O (P<0.0005) and 25.5 to 44.0 ml/cmH2O (P=0.001) and median PVR from 15 to 80 ml (P=0.001) and 15.0 to 62.5 ml (P=0.001), respectively. Median Pdet max decreased significantly from 49 to 37 cmH2O (P<0.0005) and 48.5 to 37.0 cmH2O (P=0.001), and median Pdet Qmax from 32.0 to 20.0 ml/sec (P<0.0005) and 36.0 to 21.5 ml/sec (P=0.001), respectively. The effect of BTX-A injections lasted for a median time of 5 months in both groups. Median daytime frequency, nocturia, and number of used pads decreased significantly in both groups. More than 80% of the patients were satisfied with the effect of BTX-A.


CONCLUSIONS
Patients with intractable IDO respond to intradetrusor BTX-A with a significant and comparable but temporally limited effect in urodynamic and LUTS parameters as those with NDO. The majority of patients were satisfied with treatment.
Ghalayini
Ibrahim Fathi
IF
Faculty of Medicine, Jordan University of Science & Technology, King Abdullah University Hospital, Irbid, Jordan.
Al-Ghazo
Mohammed A
MA
Faculty of Medicine, Jordan University of Science & Technology, King Abdullah University Hospital, Irbid, Jordan.
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology*; D014563:Urodynamics / Q000187:drug effects / Q000502:physiology*
D000900:Anti-Bacterial Agents; D018680:Cholinergic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A