title: Role of botulinum toxin-A in refractory idiopathic overactive bladder patients without detrusor overactivity.
abstract: BACKGROUND
  To evaluate the efficacy of intradetrusor botulinum toxin-A (BTX-A) in idiopathic overactive bladder patients (OAB) refractory to anti-muscarinic therapy, without detrusor overactivity (DOA) on urodynamics.
  
  
  METHODS
  Patients with refractory idiopathic OAB without DOA on urodynamics were prospectively enrolled. Subjects completed a 3-day voiding diary (3-VD), urogenital distress inventory-6 questionnaire (UDI-6) and graded their quality of life on a 10-cm visual analog scale (VAS) prior to study enrollment and at week 12 postinjection. All patients underwent multichannel urodynamics at study enrollment and 12 weeks postinjection. Improvement was analyzed based on 3-VD, UDI-6 questionnaire, VAS scores, and urodynamic parameters at week 12 postinjection compared to study enrollment.
  
  
  RESULTS
  The study included 32 patients. Mean ± SD age was 56 ± 16. There were 27 women and 5 men. Nineteen patients had OAB without incontinence (OAB-dry) and 13 patients had OAB with incontinence (OAB-wet). In OAB-dry patients, mean ± SD urinary frequency dropped from 24 ± 11 to 10 ± 4 by week 12. In OAB-wet patients, mean ± SD urge incontinence episodes dropped from 7.9 ± 5 to 0 ± 2.6 by week 12. Mean UDI-6 and VAS scores improved significantly in both groups by week 12 (P = 0.0001). On comparing urodynamic parameters, OAB-wet patients showed significant decrease in maximum detrusor pressure during the voiding phase at week 12 compared to baseline values (P = 0.02).
  
  
  CONCLUSIONS
  Refractory idiopathic OAB patients without DOA on urodynamics may benefit from intradetrusor BTX-A.
authors.affiliation: Department of Urology, University of Miami-Miller School of Medicine, 1150 NW 14 Street, Suite 309, Miami, FL 33136, USA. prashanth82@gmail.com
authors.forename: Prashanth
authors.initials: P
authors.lastname: Kanagarajah
authors.forename: Rajinikanth
authors.initials: R
authors.lastname: Ayyathurai
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Caruso
authors.forename: Christopher
authors.initials: C
authors.lastname: Gomez
authors.forename: Angelo E
authors.initials: AE
authors.lastname: Gousse
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009130:Muscle, Smooth / Q000502:physiology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D053202:Urinary Incontinence, Urge / Q000209:etiology; D014563:Urodynamics
chemical_list: D018727:Muscarinic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A