title: Videourodynamic changes of botulinum toxin A in patients with neurogenic bladder dysfunction (NBD) and idiopathic detrusor overactivity (IDO) refractory to drug treatment.
abstract: OBJECTIVE
  To document the videourodynamic changes and the efficacy and safety profile of botulinum toxin A (BoNT-A, Dysport(®)) in neurogenic bladder dysfunction (NBD) including neurogenic detrusor overactivity, low-compliance and break-low-compliance and idiopathic detrusor overactivity (IDO), in patients refractory to drug treatment.
  
  
  METHODS
  Sixty-four patients with NBD and 170 patients with IDO were treated between 2002 and 2007. Diagnostic approach included medical history, bladder diary, standardised questionnaire rating quality of life, sonography, videourodynamic and temporary sacral nerve block. All patients received BoNT-A-injection under local anaesthesia. Patients with NBD received 500 mouse units (MU) and patients with IDO received 250 MU BoNT-A, injected into ten sites including the trigonum. Patients were followed up 6 weeks after injection.
  
  
  RESULTS
  For NBD, 58/64 (91%) patients achieved satisfactory continence during the day as well as significant reduction in incontinence episodes and improvement in quality of life. For IDO, 158/170 (93%) were responders with regard to urgency and urge incontinence. Urodynamical changes included significant improvement in the following parameters in both groups: increase in maximum cystometric capacity and decrease in detrusor pressure. BoNT-A was well tolerated; no drug-related side effects were documented. No de novo vesicoureteral reflux was induced. Long-term follow-up revealed a mean duration effect of BoNT-A of 5.7 months in NBD and 4.9 months in IDO.
  
  
  CONCLUSIONS
  BoNT-A is highly effective in NBD as well as in IDO suggesting that this is a good treatment option for patients with detrusor overactivity. Furthermore, intratrigonal injection is safe and not associated with vesicoureteral reflux.
authors.affiliation: Department of Urology, Eberhard-Karls-University, Hoppe-Seyler-Street 3, 72076, Tübingen, Germany. saladin.alloussi@med.uni-tuebingen.de
authors.forename: S H
authors.initials: SH
authors.lastname: Alloussi
authors.forename: Ch
authors.initials: Ch
authors.lastname: Lang
authors.forename: R
authors.initials: R
authors.lastname: Eichel
authors.forename: A
authors.initials: A
authors.lastname: Al-Kaabneh
authors.forename: J
authors.initials: J
authors.lastname: Seibold
authors.forename: C
authors.initials: C
authors.lastname: Schwentner
authors.forename: S
authors.initials: S
authors.lastname: Alloussi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000188:drug therapy / Q000503:physiopathology; D053202:Urinary Incontinence, Urge / Q000188:drug therapy / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology*; D014741:Video Recording
chemical_list: D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA