title: Reduction of urgency severity is the most important factor in the subjective therapeutic outcome of intravesical onabotulinumtoxinA injection for overactive bladder.
abstract: This study investigated the relationship between the subjective outcome assessment and objective parameters after intravesical onabotulinumtoxinA injection in patients with overactive bladder (OAB).
  
  
  
  A total of 77 consecutive patients with urodynamically confirmed detrusor overactivity were treated with intravesical 100 U of onabotulinumtoxinA in 20 divided injections (5 U in 0.5 ml normal saline each) at different sites sparing the trigone. The primary end-point was the change in the Global Response Assessment (GRA) 3 months after treatment. All patients were monitored monthly after treatment for up to 6 months. Patients were divided into successful and failed treatment groups according to change in their GRA (≥2 and ≤1, respectively) at 3 months. The changes in voiding diary variables, Urgency Severity Score (USS), Overactive Bladder Symptom Score (OABSS), maximal bladder capacity (MBC), post-void residual (PVR) volume, and voiding efficiency (VE) were compared between groups at each time point.
  
  
  
  Overall, USS, OABSS, and MBC improved after treatment. Three months after BoNT-A injection, 49 (64%) patients reported an improvement in the GRA of 2 (n = 30) or 3 (n = 19). Patients with GRA ≥ 2 had significant improvements in OABSS at 3 months, and USS, OABSS, urgency urinary incontinence (UUI), and urgency episodes at 6 months compared with patients with GRA ≤ 1. No significant difference in MBC, PVR, or VE was noted between groups at 3 or 6 months.
  
  
  
  Subjectively successful treatment outcomes of intravesical onabotulinumtoxinA injection for OAB patients were associated with improvement in OAB symptoms but not increased bladder capacity. Neurourol. Urodynam. 36:338-343, 2017. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Yuan-Hong
authors.initials: YH
authors.lastname: Jiang
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: incontinence; intravesical injection; lower urinary tract symptoms