title: Successful treatment with botulinum toxin A after failed augmentation ileocystoplasty.
abstract: BACKGROUND
  A 49-year old man initially underwent clam ileocystoplasty 14 years ago. A revision of this original procedure was required 11 years ago for intractable detrusor overactivity secondary to transverse myelitis; he experienced only temporary symptomatic improvement that lasted 6 months after each procedure. Despite the use of oral anticholinergic drugs, the patient subsequently needed to perform clean intermittent self-catheterization approximately 10 times every 24 h, and when he presented to our department, he still suffered from occasional episodes of urgency incontinence that required the regular use of a penile sheath.
  
  
  METHODS
  Symptom severity was assessed using a 4-day bladder diary.
  
  
  METHODS
  Cystometry confirmed the presence of terminal detrusor overactivity.
  
  
  RESULTS
  After the patient provided his informed consent, he was treated as an outpatient with intradetrusor injections of botulinum toxin A, delivered under local anesthesia by a minimally invasive technique that used a flexible cystoscope. A significant improvement was noted in the patient's lower urinary tract symptoms, urodynamic parameters and quality of life, measured at 4 and 16 weeks after treatment. The patient was completely dry at both follow-up visits and was able to discontinue the use of anticholinergic drugs and the penile sheath for a total of 11 months.
authors.affiliation: Institute of Neurology, University College London, London, UK.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Apostolidis
authors.forename: Roshni
authors.initials: R
authors.lastname: Popat
authors.forename: Matthew
authors.initials: M
authors.lastname: Harper
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Fowler
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
mesh_terms: D000283:Administration, Intravesical; D000714:Anastomosis, Surgical; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D018570:Risk Assessment; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D014547:Urinary Diversion / Q000379:methods*; D014563:Urodynamics
chemical_list: D019274:Botulinum Toxins, Type A