The effect of botulinum toxin type a on overactive bladder symptoms in patients with multiple sclerosis: a pilot study.
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.
Mehnert
Ulrich
U
Neuro-Urology, Spinal Cord Injury Center, University of Zurich and Department of Urology, University Hospital Zurich, Zurich, Switzerland. ulrich.mehnert@paralab.balgrist.ch
Birzele
Jan
J
Reuter
Katja
K
Schurch
Brigitte
B
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
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A