title: [Definition of botulinum toxin failure in neurogenic detrusor overactivity: Preliminary results of the DETOX survey].
abstract: OBJECTIVE
  There is currently no guideline regarding the management of neurogenic detrusor overactivity (NDO) refractory to intra-detrusor botulinum toxin injections. The primary objective of the present study was to find a consensus definition of failure of botulinum toxin intra-detrusor injections for NDO. The secondary objective was to report current trends in the managment of NDO refractory to botulinum toxin.
  
  
  METHODS
  A survey was created, based on data drawn from current literature, and sent via e-mail to all the experts form the Group for research in neurourology in french language (GENULF) and from the comittee of neurourology of the French urological association (AFU). The experts who did not answer to the first e-mail were contacted again twice. Main results from the survey are presented and expressed as numbers and proportions.
  
  
  RESULTS
  Out of the 42 experts contacted, 21 responded to the survey. Nineteen participants considered that the definition of failure should be a combination of clinical and urodynamics criteria. Among the urodynamics criteria, the persistence of a maximum detrusor pressure>40 cm H2O was the most supported by the experts (18/21, 85%). According to the vast majority of participants (19/21, 90.5%), the impact of injections on urinary incontinence should be included in the definition of failure. Regarding the management, most experts considered that the first line treatment in case of failure of a first intra-detrusor injection of Botox(®) 200 U should be a repeat injection of Botox(®) at a higher dosage (300 U) (15/20, 75%), regardless of the presence or not of urodynamics risk factors of upper tract damage (16/20, 80%).
  
  
  CONCLUSIONS
  This work has provided a first overview of the definition of failure of intra-detrusor injections of botulinum toxin in the management of NDO. For 90.5% of the experts involved, the definition of failure should be clinical and urodynamic and most participants (75%) considered that, in case of failure of a first injection of Botox(®) 200 U, repeat injection of Botox(®) 300 U should be the first line treatment.
authors: Service d'urologie, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France. Electronic address: peyronnetbenoit@hotmail.fr.
authors: B
authors: B
authors: Peyronnet
authors: Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Toulouse, France.
authors: S
authors: S
authors: Sanson
authors: Service de neuro-urologie, hôpital Tenon, Paris, France.
authors: G
authors: G
authors: Amarenco
authors: Service de médecine physique et réadaptation, CHU Rangeuil, Toulouse, France.
authors: E
authors: E
authors: Castel-Lacanal
authors: Service d'urologie, hôpital Pitié-Salpétrière, Paris, France.
authors: E
authors: E
authors: Chartier-Kastler
authors: Service de médecine physique et réadaptation, hospices civils de Lyon, Saint-Genis-Laval, France.
authors: K
authors: K
authors: Charvier
authors: Service de médecine physique et réadaptation, hôpital Pontchaillou, Rennes, France.
authors: M
authors: M
authors: Damphousse
authors: Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, Garches, France.
authors: P
authors: P
authors: Denys
authors: Cabinet de neuro-urologie, clinique Saint-Augustin, Bordeaux, France.
authors: M
authors: M
authors: de Seze
authors: Service de médecine physique et réadaptation, Centre de L'Arche, Saint-Saturnin, France.
authors: G
authors: G
authors: Egon
authors: Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, Garches, France.
authors: A
authors: A
authors: Even
authors: Unité pédiatrique de médecine physique et rééducation, hôpital Trousseau, Paris, France.
authors: V
authors: V
authors: Forin
authors: Service d'urologie, hôpital La Conception, Marseille, France.
authors: G
authors: G
authors: Karsenty
authors: Centre de rééducation de Kerpape, Ploemeur, France.
authors: J
authors: J
authors: Kerdraon
authors: Service d'urologie, Hôtel-Dieu, Nantes, France.
authors: L
authors: L
authors: le Normand
authors: Service de médecine physique et réadaptation, hôpital Mondor, Créteil, France.
authors: C-M
authors: CM
authors: Loche
authors: Service d'urologie, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
authors: A
authors: A
authors: Manunta
authors: Service d'urologie, nouvel hôpital civil, Strasbourg, France.
authors: P
authors: P
authors: Mouracade
authors: Service d'urologie, hôpital Pitié-Salpétrière, Paris, France.
authors: V
authors: V
authors: Phe
authors: Département médullaire, fondation Hopale, Berck-sur-mer, France.
authors: J-G
authors: JG
authors: Previnaire
authors: Service d'urologie, centre hospitalier Lyon Sud, Pierre-Bénite, France.
authors: A
authors: A
authors: Ruffion
authors: Service d'urologie, nouvel hôpital civil, Strasbourg, France.
authors: C
authors: C
authors: Saussine
authors: Service de neuroréhabilitation, CHUV, Lausanne, Suisse.
authors: B
authors: B
authors: Schurch
authors: Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Toulouse, France.
authors: X
authors: X
authors: Game
mesh_terms: D000283:Administration, Intravesical; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Detrusor overactivity; Failure; Hyperactivité détrusorienne; Injections; Neurogenic; Neurogène; Toxine botulique; Échec