Patients' perspective of botulinum toxin-A as a long-term treatment option for neurogenic detrusor overactivity secondary to spinal cord injury.
OBJECTIVE
To evaluate patients' perspective on whether they would consider botulinum toxin-A (BTX-A) injections as a long-term treatment option for managing their neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI).


METHODS
In all, 72 patients with SCI and urodynamically confirmed NDO refractory to anticholinergics, who have had at least one or more injections with BTX-A were invited to participate in a 5-min telephone questionnaire covering various aspects of their treatment. Questions about patient satisfaction were rated on a scale from 1 to 10 (1, not satisfied; to 10, very satisfied).


RESULTS
Of the 72 patients surveyed, 48 (67%) were still actively undergoing repeat BTX-A injections. The mean patient satisfaction score was 6.2. Of the 48 patients, 43 (90%) replied that they would consider continuing with BTX-A injections as a long-term treatment option. Only seven (15%) of patients still having BTX-A injections would consider an alternative permanent surgical option in the next 5 years. Of those patients considering a one-off permanent surgical solution, younger patients were likely to consider this at a later interval than those in an older group (Spearman's correlation coefficient, -0.52, 95% confidence interval -0.78 to -0.10, P = 0.02). The annual new patient recruitment rate was high (mean 14.4) and the annual withdrawal rate was low (mean 4.8).


CONCLUSIONS
With high satisfaction and low annual withdrawal rates, there are increasingly many patients on BTX-A. Most consider continuing BTX-A injections in the long term, increasing the future demand for this service. There is an urgent need for further research into optimizing the current delivery of an intradetrusor BTX-A injection service for patients with NDO.
Hori
Satoshi
S
Department of Neuro-urology and Spinal Research Centre, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. satoshi@doctors.org.uk
Patki
Prasad
P
Attar
Kaka H
KH
Ismail
Soran
S
Vasconcelos
Joana C
JC
Shah
P Julian R
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017060:Patient Satisfaction; D013119:Spinal Cord Injuries / Q000150:complications*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A