title: The effect of botulinum toxin type a on overactive bladder symptoms in patients with multiple sclerosis: a pilot study.
abstract: OBJECTIVE
  Patients with multiple sclerosis often experience overactive bladder symptoms. High dose intradetrusor botulinum toxin A treatment is effective but often results in urinary retention and urinary diversion via a catheter. In this pilot study we evaluated whether only 100 U botulinum toxin A would significantly decrease overactive bladder symptoms in patients with multiple sclerosis without impairing pretreatment voluntary voiding.
  
  
  METHODS
  Included in our study were 12 patients with multiple sclerosis who had overactive bladder symptoms such as urgency, frequency and/or urgency incontinence. The treatment effect was evaluated using data on 3 consecutive visits, that is before, and a mean +/- SD of 46.2 +/- 11.9 and 101 +/- 21 days after intradetrusor injection of 100 U Botox, including the results of cystometry and uroflowmetry at visits 1 and 2, and uroflowmetry alone at visit 3. Patients completed a 3-day voiding diary for all 3 visits.
  
  
  RESULTS
  Maximum bladder capacity significantly increased and maximum detrusor pressure decreased. Daytime and nighttime frequency, urgency and pad use significantly decreased. Post-void residual volume significantly increased initially but decreased until 12 weeks. Median time to re-injection due to recurrent overactive bladder symptoms was 8 months.
  
  
  CONCLUSIONS
  Overactive bladder treatment in patients with multiple sclerosis using 100 U Botox intradetrusor injections seems to be effective and safe. Despite slightly impaired detrusor contractility most patients still voided voluntarily without symptoms. Thus, 100 U Botox may be a reasonable treatment option for overactive bladder symptoms in patients with multiple sclerosis who still void voluntarily.
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center, University of Zurich and Department of Urology, University Hospital Zurich, Zurich, Switzerland. ulrich.mehnert@paralab.balgrist.ch
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mehnert
authors.forename: Jan
authors.initials: J
authors.lastname: Birzele
authors.forename: Katja
authors.initials: K
authors.lastname: Reuter
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schurch
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D014546:Urinary Catheterization / Q000706:statistics & numerical data
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A