Efficacy and safety of the first and repeated intradetrusor injections of abobotulinum toxin A 750 U for treating neurological detrusor overactivity.
OBJECTIVE
To assess clinical and urodynamic efficacy of the first and repeated intradetrusor injections of abobotulinum toxin A (Dysport(®), Ipsen(®), France) in patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergic treatment.


METHODS
A single-center retrospective study was conducted in 81 consecutive patients who had never received any botulinum toxin intradetrusor injections. They were treated with at least one 750 U intradetrusor injection of abobotulinum toxin A. All patients performed clean intermittent self-catheterization (CIC) before injections. Success was defined as a combination of no incontinence episode, a number of catheterization <8 reported in a 3-day bladder diary and the lack of detrusor overactivity.


RESULTS
Six weeks after the first injection, the success rate was 64.2 %. The proportion of continent patients was 80.2 %, the mean number of CIC per 24 h reduced (-3.55, p < 0.0001) and the mean catheterization volume increased (+237.3 ml, p < 0.0001). Regarding urodynamics, mean maximum cystometric capacity and mean volume at the first uninhibited contraction increased (+132.7 ml, p < 0.0001 and +180 ml, p < 0.0001, respectively) and mean maximum bladder pressure decreased significantly (-21.5 cm H2O, p < 0.0001). Mean reinjection number was 3.9 and mean interval between reinjection was 8.8 ± 3 months. The clinical efficacy rate after each reinjection (up to fourteen) was at least 86.7 %. Out of 55 patients who underwent repeated injections, secondary resistance was noted in 2 (3.6 %).


CONCLUSIONS
The results of the present study are in favor of a long-term safety and efficacy of abobotulinum toxin A 750 U for NDO.
Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France. peyronnetbenoit@hotmail.fr.|Service d'urologie, CHU Rennes, Rennes, France. peyronnetbenoit@hotmail.fr.
Benoit
B
Peyronnet
Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France.
Mathieu
M
Roumiguié
Service de Médecine Physique et Réadaptation, CHU Rangueil, Toulouse, France.
Evelyne
E
Castel-Lacanal
Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France.|Service d'urologie, Clinique Pasteur, Toulouse, France.
Julien
J
Guillotreau
Service de Médecine Physique et Réadaptation, CHU Rangueil, Toulouse, France.
Philippe
P
Marque
Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France.
Pascal
P
Rischmann
Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France.
Xavier
X
Gamé
D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000283:Administration, Intravesical; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA
Abobotulinum toxin A; Long-term; Multiple sclerosis; Neurogenic bladder; Spinal cord injury; Urinary incontinence