title: [Intra-detrusor injection of botulinum toxin for female refractory idiopathic overactive bladder syndrome].
abstract: BACKGROUND
  Botulinum toxin-A detrusor injections are now approved for use (extension of marketing authorization) in the management of refractory idiopathic overactive bladder. The goal of the current study was to study the value and efficacy of this therapy.
  
  
  METHODS
  A literature review was performed on Medline, Embase and Cochrane databases, using the following keywords: botulinum toxin; overactive bladder syndrome; urinary incontinence; detrusor injection.
  
  
  RESULTS
  The recommended first step dose is 50 units of BOTOX(©) (dose selected for tolerance assessment). However, the cure rates for urge incontinence are greater with 100 units. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by the patient, because of the risk of urinary retention (6%). The administration of BOTOX(©) comprises an intra-detrusor injection using a cystoscope, performed under local anesthesia. Clinical improvement is generally observed in the first two weeks after the injection. Patients should be considered for reinjection when the clinical effect of the previous injection has diminished, approximately 6-9 months after the first injection. An injection of 100 units may be considered when the clinical benefit of the 50-unit injection is not satisfactory concerning incontinence symptoms.
  
  
  CONCLUSIONS
  Botulinum toxin detrusor injections may be offered to women who develop refractory OAB.
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, groupe hospitalier universitaire Sud, Assistance publique-Hôpitaux de Paris (AP-HP), 157, rue de La-Porte-de-Trivaux, 92414 Clamart, France. Electronic address: xavier.deffieux@abc.aphp.fr.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Service de gynécologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Fatton
authors.affiliation: Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
authors.forename: P
authors.initials: P
authors.lastname: Denys
authors.affiliation: Service d'urologie, hôpital de la Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Chartier-Kastler
authors.affiliation: Service de rééducation neuro-urologique, hôpital Tenon, 4, rue de La-Chine, 75020 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Amarenco
authors.affiliation: Service d'urologie, hôpital Tenon, 4, rue de La-Chine, 75020 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Haab
authors.affiliation: Service d'urologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Costa
authors.affiliation: Service d'urologie, hôpital de Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: X
authors.initials: X
authors.lastname: Game
authors.affiliation: Service d'urologie, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Karsenty
authors.affiliation: Service d'urologie, centre hospitalier universitaire, 1, place de l'Hôpital, 67000 Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Saussine
authors.affiliation: Service d'urologie, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Ballanger
authors.affiliation: Service d'urologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: L
authors.initials: L
authors.lastname: Le Normand
authors.affiliation: Service d'urologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
authors.forename: A
authors.initials: A
authors.lastname: Ruffion
authors.affiliation: Service d'urologie, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Hermieu
authors.affiliation: Service de gynécologie, CHRU de Lille, rue Eugène-Avinée, 59037 Lille cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Cosson
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006801:Humans; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000494:pharmacology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Hyperactivité vésicale; Incontinence sur urgenturies; Injection intra-détruosrienne; Intra-detrusor injection; Overactive bladder syndrom; Toxine botulinique; Urge incontinence; Urinary incontinence