title: Botulinum toxin outcomes for idiopathic overactive bladder stratified by indication: lack of anticholinergic efficacy versus intolerability.
abstract: OBJECTIVE
  To determine if the outcomes of intradetrusor botulinum toxin A (BTX-A) injections for the management of refractory overactive bladder (OAB) symptoms are different if performed due to lack of anticholinergic efficacy versus medication intolerability.
  
  
  METHODS
  Retrospective chart review was performed on all patients undergoing intradetrusor BTX-A (BOTOX®, Allergan Inc., Irvine, CA) injections from 2004 to 2010 for the management of refractory idiopathic OAB with or without urge incontinence. All patients failed anticholinergic medications due to either lack of efficacy or intolerable side effects. Patient outcomes following BTX-A injections (150-200 units) were compared based on the primary reason for discontinuing anticholinergic medications (lack of efficacy vs. intolerability). Successful BTX-A injections were defined as those producing symptomatic OAB improvement warranting future repeat injections upon return of symptoms.
  
  
  RESULTS
  A total of 85 patients were included in the study. Overall, 58/85 (68%) reported symptomatic improvement following BTX-A injections. Successful outcomes were reported in 34/57 (60%) patients treated secondary to lack of anticholinergic efficacy versus 24/28 (86%) due to intolerable side effects (P = 0.02).
  
  
  CONCLUSIONS
  BTX-A injections are more successful in patients with anticholinergic intolerability as compared to patients with poor medication efficacy (86% vs. 60%, P = 0.02).
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Iryna
authors.initials: I
authors.lastname: Makovey
authors.forename: Tanya
authors.initials: T
authors.lastname: Davis
authors.forename: Michael L
authors.initials: ML
authors.lastname: Guralnick
authors.forename: R Corey
authors.initials: RC
authors.lastname: O'Connor
mesh_terms: D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000009:adverse effects*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000188:drug therapy*; D014922:Wisconsin
chemical_list: D000924:Anticholesteremic Agents; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A