Comparison of effectiveness of detrusor, suburothelial and bladder base injections of botulinum toxin a for idiopathic detrusor overactivity.
OBJECTIVE
We compared the effectiveness of detrusor, suburothelial and bladder base injections of botulinum toxin type A in patients with idiopathic detrusor overactivity.


METHODS
A total of 45 patients with idiopathic detrusor overactivity refractory to antimuscarinic therapy were randomly allocated to receive 100 U botulinum toxin type A injected into detrusor, suburothelial and bladder base. Videourodynamic studies were performed at baseline and 3 months after treatment. Data collected included symptom score, urgency and incontinence episodes, and urgency severity score. A general satisfaction rating was also assessed as excellent, moderately improved, mildly improved or stationary. A moderately improved or excellent result was defined as successful treatment.


RESULTS
A total of 15 patients were allocated to each treatment group. A successful result at 3 months was achieved in 14 (93%) patients with detrusor, 12 (80%) with suburothelial and 10 (67%) with bladder base injection. The success rate in the detrusor, suburothelial and bladder base injection groups decreased with time to 67%, 47% and 13% by 6 months, and 20%, 20% and 6.7% at 9 months, respectively (p = 0.0253). Vesicoureteral reflux was not found in any patient after botulinum toxin type A injection. Urgency severity scores improved significantly in all groups after treatment. At 3 months after treatment significant increases in cystometric capacity and post-void residual compared to baseline were found in the detrusor and suburothelial but not in the bladder base group.


CONCLUSIONS
Intravesical injection of 100 U botulinum toxin type A by all 3 methods had a therapeutic effect on idiopathic detrusor overactivity. Bladder base botulinum toxin type A injection relieved urgency sensation but did not increase bladder capacity.
Kuo
Hann-Chorng
HC
Department of Urology, Buddhist Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualien, Taiwan. hck@tzuchi.com.tw
D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D001743:Urinary Bladder / Q000187:drug effects; D053201:Urinary Bladder, Overactive / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014563:Urodynamics / Q000187:drug effects / Q000502:physiology; D014567:Urography; D019459:Urothelium / Q000187:drug effects
D019274:Botulinum Toxins, Type A