title: Reduction of urgency severity is associated with long-term therapeutic effect after intravesical onabotulinumtoxin A injection for idiopathic detrusor overactivity.
abstract: OBJECTIVE
  Intravesical onabotulinumtoxin A (BoNT-A) injection is a promising treatment for refractory detrusor overactivity (DO). This study investigated the long-term success rate of BoNT-A injection for patients with idiopathic DO and its association with reduction of urgency severity.
  
  
  METHODS
  This study was a retrospective analysis of 174 patients with idiopathic DO who received first-time 100  U BoNT-A injections. The patients were collected from several previous clinical trials. The therapeutic effects were classified as significant sensory effects with urgency severity score reductions of ≥2 and/or significant motor effects with cystometric bladder capacity increases of ≥25%. The treatment results based on patients' perceptions of bladder conditions and long-term success rates were analyzed among the different therapeutic-effect subgroups.
  
  
  RESULTS
  A successful outcome was reported by 138 (79.3%) patients at 3 months. Seventy-seven (44.3%) patients had both sensory and motor effects, 5 (2.9%) had sensory effects alone, 83 (47.7%) had motor effects alone, and 9 (5.2%) had no sensory or motor effect. All 82 patients with sensory with/without motor effects reported a successful result. In contrast, only 50 (60.2%) patients with motor effects alone reported success at 3 months. Increased cystometric bladder capacity and postvoid residual and decreased voiding efficiency were noted in patients with motor with/without sensory effects. The therapeutic results lasted significantly longer in patients with sensory with/without motor effects than those with motor effects alone.
  
  
  CONCLUSIONS
  Improvement of urgency severity is significantly associated with a higher success rate at 3 months and longer therapeutic duration after intravesical BoNT-A injection for IDO.
authors: Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan. hck@tzuchi.com.tw
authors: Hann-Chorng
authors: HC
authors: Kuo
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000187:drug effects; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010465:Perception; D012189:Retrospective Studies; D011984:Sensory Receptor Cells / Q000187:drug effects; D012720:Severity of Illness Index; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects* / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D053202:Urinary Incontinence, Urge / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A