Botulinum toxin a for idiopathic detrusor overactivity.
BACKGROUND
This prospective study aims to evaluate botulinum toxin type A (BTX-A, Botox ®) as a treatment for idiopathic detrusor overactivity (IDO) for patients with symptoms of overactive bladder (OAB).


METHODS
Nineteen patients with IDO were treated with intradetrusal injection of 200 units of BTX-A under cystoscopic guidance. There were 10 males and 9 females, with a mean age of 60 years (range, 38 to 87). Subjective responses were measured using the International Prostate Symptom Score and quality of life (QOL) score, as well as incontinent episodes, functional capacity and voiding intervals obtained from the voiding diary. They were recorded prior to, and at 6 weeks, 3, 6 and 9 months after BTX-A injections. Urodynamic studies were performed between 6 weeks to 3 months post-treatment.


RESULTS
There was statistically significant improvement in subjective parameters at 3 months post-treatment involving QOL (P = 0.002), incontinence episodes (P = 0.004), functional capacity (P = 0.01) and voiding interval (P <0.001). Reflex volume was significantly increased (P = 0.003), and maximal detrusal pressure (P = 0.001) as well as leak volume (P = 0.013) were significantly decreased during follow-up. Results of a gender-based subgroup analysis reveal that BTX-A may be more efficacious in females. Observed side effects included a patient who needed to perform CISC for about 3 months, a patient who had gross haematuria needed bladder washout and 3 patients who required treatments for urinary tract infection.


CONCLUSIONS
Overall BTX-A, which is well received by most patients, has become a very important part of the armamentarium for the treatment of IDO.
Department of Urology, Singapore General Hospital, Singapore.
Kwok Ying
KY
Lie
Michael Y C
MY
Wong
Lay Guat
LG
Ng
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011788:Quality of Life / Q000523:psychology; D001743:Urinary Bladder / Q000166:cytology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000523:psychology; D014563:Urodynamics
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A