title: An effective day case treatment combination for refractory neuropathic mixed incontinence.
abstract: OBJECTIVE
  Women with drug refractory neurogenic mixed incontinence (NMI) have limited minimally invasive treatment options and require reconstructive surgery. We examined efficacy of a combination of day case intradetrusor (ID) botulinum toxin (BTX-A) bladder injections and transobturator (TOT) or tension free vaginal tape (TVT).
  
  
  METHODS
  Eleven women who are pharmacotherapy intolerant or who have drug refractory NMI were treated. Two opted for open surgery and the remaining 9 received 1000 units of Dysport diluted in 30 mL saline cystoscopically at 30 ID sites followed by TOT in 6 or TVT in 3 as a day case combination treatment. Patient demographics, pre and post treatment videocystometrogram (VCMG), pad test and International Committee on Incontinence Questionnaire (ICIQ) scores were recorded. At 6 weeks (repeat ICIQ, pad test and patient satisfaction), at 3 and 12 months (VCMG) and 'current' (ICIQ and patient satisfaction) was recorded.
  
  
  RESULTS
  The mean age was 56.7 years (range 41 to 78) with a mean follow up of 19.1 months (range 7 to 33). All women were continent at 3 and 12 months. Quality of life (ICIQ scores) improved at 6 weeks (p > 0.001) and remained stable up to the last follow up (p > 0.001). Eight women have stopped using pads. At 3 months, there was significant improvement in MDP (p > 0.014) and MCC (p = 0.002). Anticholinergics were discontinued in 7 with global high satisfaction with the treatment BTX-A injections were repeated in 4 (mean 13.5 months).
  
  
  CONCLUSIONS
  Anticholinergic refractory women with NMI can be effectively treated as a day case with combination of ID BTX-A injections and TVT or TOT.
authors.affiliation: Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK. prasadpatki@hotmail.com
authors.forename: Prasad
authors.initials: P
authors.lastname: Patki
authors.forename: Joe B
authors.initials: JB
authors.lastname: Woodhouse
authors.forename: Krishna
authors.initials: K
authors.lastname: Patil
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamid
authors.forename: Julian
authors.initials: J
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003631:Day Care, Medical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications*; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000188:drug therapy* / Q000601:surgery
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A