title: Failure of botulinum toxin injection for neurogenic detrusor overactivity: Switch of toxin versus second injection of the same toxin.
abstract: OBJECTIVE
  To evaluate the efficacy of a second injection of the same toxin versus switching to a different botulinum toxin A after failure of a first detrusor injection in patients with neurogenic detrusor overactivity.
  
  
  METHODS
  The charts of all patients who underwent detrusor injections of botulinum toxin A (either abobotulinumtoxinA or onabotulinumtoxinA) for the management of neurogenic detrusor overactivity at a single institution were retrospectively reviewed. Patients in whom a first detrusor injection had failed were included in the present study. They were managed by a second injection of the same toxin at the same dosage or by a new detrusor injection using a different botulinum toxin A. Success was defined as a resolution of urgency, urinary incontinence and detrusor overactivity in a patient self-catheterizing seven times or less per 24 h.
  
  
  RESULTS
  A total of 58 patients were included for analysis. A toxin switch was carried out in 29 patients, whereas the other 29 patients received a reinjection of the same toxin at the same dose. The success rate was higher in patients who received a toxin switch (51.7% vs. 24.1%, P = 0.03). Patients treated with a switch from abobotulinumtoxinA to onabotulinumtoxinA and those treated with a switch from onabotulinumtoxinA to abobotulinumtoxinA had similar success rates (52.9% vs. 50%, P = 0.88).
  
  
  CONCLUSIONS
  After failure of a first detrusor injection of botulinum toxin for neurogenic detrusor overactivity, a switch to a different toxin seems to be more effective than a second injection of the same toxin. The replacement of onabotulinumtoxin by abobotulinumtoxin or the reverse provides similar results.
authors.affiliation: Department of Urology, CHU Rangueil, Toulouse, France.|Department of Urology, CHU Rennes, Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Department of Physical Medicine, CHU Rangueil, Toulouse, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Castel-Lacanal
authors.affiliation: Department of Urology, CHU Rennes, Rennes, France.
authors.forename: Andréa
authors.initials: A
authors.lastname: Manunta
authors.affiliation: Department of Urology, CHU Rangueil, Toulouse, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.affiliation: Department of Physical Medicine, CHU Rangueil, Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Marque
authors.affiliation: Department of Urology, CHU Rangueil, Toulouse, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Rischmann
authors.affiliation: Department of Urology, CHU Rangueil, Toulouse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Gamé
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D017211:Treatment Failure; D001750:Urinary Bladder, Neurogenic / Q000150:complications*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA
keywords: botulinum toxin; detrusor overactivity; neurogenic bladder; switch; urinary incontinence