title: Do repeat intradetrusor botulinum toxin type a injections yield valuable results? Clinical and urodynamic results after five injections in patients with neurogenic detrusor overactivity.
abstract: OBJECTIVE
  To study repeat intradetrusor botulinum toxin injections for the treatment of neurogenic detrusor overactivity in terms of safety and improvement of continence status and urodynamic parameters.
  
  
  METHODS
  This study was based on 20 consecutive patients (13 males, 7 females; median age, 41.1 yr) who received at least five intradetrusor injections of botulinum toxin and who were followed by clinical and urodynamic evaluation after at least four injections. The results of 100 injections and corresponding follow-ups were analyzed and compared with baseline.
  
  
  RESULTS
  No toxin-related side effects were observed after the first or repeat injections. All patients had a baseline urodynamic study and at least four urodynamic studies after botulinum toxin injections. Clinical continence improved significantly after the first injection and then remained constant after repeat injections. The median reflex volume increased significantly from a median of 200 ml at baseline to values between 440 and 500 ml at follow-up studies. The presence of neurogenic detrusor overactivity decreased significantly by 60-75%. Maximum cystometric capacity increased significantly 2.3-fold. Maximum detrusor pressure during cystometry decreased significantly 5.8-fold from a median of 70 cm H(2)O to values of about 20 cm H(2)O. Median compliance at baseline (60 ml/cm H(2)O) did not change significantly.
  
  
  CONCLUSIONS
  Repeat intradetrusor botulinum toxin A injections are a safe and valuable treatment option for neurogenic detrusor overactivity over a period of several years. The beneficial effect of the toxin on clinical and urodynamic parameters remains constant after repeat injections.
authors: Department of Urology, Hôpital de la Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, France.
authors: André
authors: A
authors: Reitz
authors: Pierre
authors: P
authors: Denys
authors: Christophe
authors: C
authors: Fermanian
authors: Brigitte
authors: B
authors: Schurch
authors: Eva
authors: E
authors: Comperat
authors: Emmanuel
authors: E
authors: Chartier-Kastler
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects*
chemical_list: D019274:Botulinum Toxins, Type A