title: Guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management: Translation of French recommendations.
abstract: OBJECTIVE
  Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management.
  
  
  METHODS
  Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts.
  
  
  RESULTS
  In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1 mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200 mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection.
  
  
  CONCLUSIONS
  Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio.
authors.affiliation: Service d'urologie, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France. Electronic address: jean-francois.hermieu@bch.aphp.fr.
authors.forename: J-F
authors.initials: JF
authors.lastname: Hermieu
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 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 de la Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: É
authors.initials: É
authors.lastname: Chartier-Kastler
authors.affiliation: Service de gynécologie, CHRU de Lille, rue Eugène-Avinée, 59037 Lille cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Cosson
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 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 d'urologie, CHU, 1, place de l'Hôpital, 67000 Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Saussine
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 Rangueil, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
authors.forename: X
authors.initials: X
authors.lastname: Gamé
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, hôpital de la conception, 147, boulevard Baille, 13005 Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Karsenty
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 de gynécologie-obstétrique, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D006801:Humans; D009465:Neuromuscular Agents; D017410:Practice Guidelines as Topic; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botox(®); Botulinum toxin; Hyperactivité vésicale idiopathique réfractaire; Refractory idiopathic overactive bladder; Toxine botulinique; Urodynamic; Urodynamique