Long-term outcome of the use of intravesical botulinum toxin for the treatment of overactive bladder (OAB).
OBJECTIVE
To assess the long-term compliance with repeated injections of intravesical botulinum toxin (BT) in a 'real-life' mixed population of patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity. To identify the reasons why patients discontinued BT therapy and to explore the outcomes of those patients who did discontinue treatment.


METHODS
Retrospective evaluation of the case notes of a series of patients who had received intravesical BT treatment at a large UK teaching hospital. No antibiotic prophylaxis was given for the procedure.


RESULTS
Over a period of 7 years, 268 patients were initiated on intravesical BT treatment for overactive bladder (OAB) at our institution, with 137 followed up for ≥36 months, with 80 patients having ≥60 months follow-up after their first injection. Almost two-thirds of patients (61.3%) had discontinued intravesical BT therapy at 36 months, with a 63.8% discontinuation rate at 60 months. The main reasons for discontinuation were tolerability issues, mainly urinary tract infections and the need for clean intermittent self-catheterisation. Primary and secondary losses of efficacy were of secondary importance. Most of the patients that discontinued have remained under urology care and now receive alternative methods of treatment.


CONCLUSIONS
Intravesical BT therapy is an effective short-term treatment for OAB. With time, two-thirds of patients discontinued treatment usually because of the tolerability issues associated with treatment.
Department of Urology, St James University Hospital, Leeds, UK. amar.mohee@gmail.com
Amar
A
Mohee
Ayisha
A
Khan
Neil
N
Harris
Ian
I
Eardley
D000283:Administration, Intravesical; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A