title: Botulinum toxin A submucosal injection for refractory non-neurogenic overactive bladder: early outcomes.
abstract: The objective of the present study was to assess the short-term effects of botulinum toxin A (BTX-A) injection for refractory non-neurogenic overactive bladder (OAB) in the setting of a prospective multicenter clinical trial. Refractory OAB was defined as persistent urgency urinary incontinence (UUI) ≥ once a week despite taking anticholinergic agents, or the incapability to continue the agents because of the adverse effects. A total of 100 U of BTX-A were reconstituted in 15 mL of normal saline and an aliquot of 0.5 mL was injected at 30 submucosal sites of the bladder wall. Nine men and eight women aged 67 ± 12 years were included. Subjective daytime frequency, urgency and UUI significantly decreased after treatment. On a 3-day frequency-volume chart, the daytime and night-time frequency of UUI significantly decreased from 5.5 and 0.5 pre-injection to 2.0 and 0.3 postinjection, respectively. Daytime urinary incontinence completely disappeared in six subjects. A urodynamic study showed the disappearance of detrusor overactivity in eight patients and a decrease in five patients. Maximum bladder capacity significantly increased from 179.9 to 267.3 mL. Difficulty on micturition or feeling of incomplete emptying was reported by 23.5% and 43.8% of patients at weeks 2 and 4, respectively. Postvoid residual urine increased to >100 mL in seven patients and >200 mL in one patient after injection; however, none of the patients required clean intermittent catheterization. These findings suggest promising efficacy of BTX-A in Japanese OAB patients.
authors.affiliation: Division of Urology, Department of Surgery and Intensive Care, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan. kokamura@ncgg.go.jp
authors.forename: Kikuo
authors.initials: K
authors.lastname: Okamura
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Nojiri
authors.forename: Kaname
authors.initials: K
authors.lastname: Ameda
authors.forename: Takashige
authors.initials: T
authors.lastname: Namima
authors.forename: Masahito
authors.initials: M
authors.lastname: Suzuki
authors.forename: Katsumi
authors.initials: K
authors.lastname: Inoue
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Ogawa
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
authors.forename: Yukio
authors.initials: Y
authors.lastname: Homma
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A