title: Clean intermittent self-catheterization after botulinum neurotoxin type A injections: short-term effect on quality of life.
abstract: OBJECTIVE
  To investigate the hypothesis that the need for clean intermittent self-catheterization after botulinum neurotoxin type A injections is outweighed by the efficacy of this treatment, so that clean intermittent self-catheterization is not a burden for patients with refractory idiopathic detrusor overactivity.
  
  
  METHODS
  Women undergoing intradetrusor injections of 200 units botulinum neurotoxin type A for refractory idiopathic detrusor overactivity were evaluated prospectively. Clean intermittent self-catheterization was discussed with all patients and its possible need after botulinum neurotoxin type A treatment. As indicator of quality of life, lower urinary tract symptom distress and effect on daily activities were assessed using the validated Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) before and 4 weeks after receiving botulinum neurotoxin type A injections.
  
  
  RESULTS
  Mean age of the 65 women was 51 years, and all voided spontaneously before botulinum neurotoxin type A injections. After botulinum neurotoxin type A treatment, 28 (43%) required clean intermittent self-catheterization. Mean UDI-6 and IIQ-7 scores reduced from 61 to 33 (P<.001) and 62 to 30 (P<.001) in women performing clean intermittent self-catheterization and from 60 to 28 (P<.001) and 64 to 25 (P<.001) in those who did not, respectively. Comparison of quality of life in women performing clean intermittent self-catheterization and in those who did not revealed no significant differences before and after botulinum neurotoxin type A treatment.
  
  
  CONCLUSIONS
  Clean intermittent self-catheterization after botulinum neurotoxin type A intradetrusor injections did not impair quality of life in appropriately informed and selected women in the short term. All patients should be informed of the potential need for clean intermittent self-catheterization after botulinum neurotoxin type A injections, and a willingness to do so should be a prerequisite for this still unlicensed off-label treatment.
authors.affiliation: From the Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, University College London Institute of Neurology, London, United Kingdom; and Department of Urology, Ludwig-Maximilians-University, München, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
authors.forename: Shahid
authors.initials: S
authors.lastname: Khan
authors.forename: Jalesh
authors.initials: J
authors.lastname: Panicker
authors.forename: Alexander
authors.initials: A
authors.lastname: Roosen
authors.forename: Sohier
authors.initials: S
authors.lastname: Elneil
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Fowler
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000523:psychology / Q000628:therapy*; D014546:Urinary Catheterization; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A