title: Complete continence after botulinum neurotoxin type A injections for refractory idiopathic detrusor overactivity incontinence: patient-reported outcome at 4 weeks.
abstract: BACKGROUND
  Objective improvement following intradetrusor injections of botulinum neurotoxin type A (BoNTA) is well documented. Although patient-related outcome measures are highly recommended for monitoring overactive bladder symptoms, no study before has dealt with the question of patient-reported complete continence after BoNTA treatment using validated questionnaires.
  
  
  OBJECTIVE
  To investigate the change in patient-reported continence rate after intradetrusor injections of BoNTA for treatment of refractory idiopathic detrusor overactivity (IDO) incontinence.
  
  
  METHODS
  Seventy-four patients (51 women, 23 men) with refractory IDO incontinence treated for the first time with intradetrusor injections of 200 U BoNTA were evaluated in this nonrandomised, open-label, cohort study.
  
  
  METHODS
  Changes in patient-reported urinary frequency, urgency incontinence, and stress incontinence were assessed using the condition-specific validated short form of the Urogenital Distress Inventory (UDI 6) before and 4 wk after BoNTA treatment.
  
  
  CONCLUSIONS
  The patient-reported outcome of complete continence (defined as a score of 0 in both the urgency and stress incontinence subscales of the UDI 6) was 51% (38 of 74) 4 wk after intradetrusor injections of BoNTA. In patients who were not completely continent, median urgency incontinence scores reduced significantly from 100 to 0 (p<0.001), stress incontinence scores from 33 to 0 (p<0.001), and median urinary frequency scores from 100 to 33 (p<0.001), respectively. The inclusion of patients with mixed incontinence may have resulted in underestimation of the complete continence rate.
  
  
  CONCLUSIONS
  An excellent response with >50% of patients reporting complete continence 4 wk after BoNTA treatment reveals the efficacy of this emerging treatment for patients with refractory IDO incontinence. Furthermore, in those in whom complete continence was not achieved, there was a notable and significant reduction in reported urgency incontinence, stress incontinence, and urinary frequency.
authors.affiliation: Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
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: Gwen
authors.initials: G
authors.lastname: Gonzales
authors.forename: Sohier
authors.initials: S
authors.lastname: Elneil
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Fowler
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
mesh_terms: D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000008:administration & dosage*; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000150:complications / Q000188:drug therapy*
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A