title: Efficacy and Safety of Intravesical OnabotulinumtoxinA Injection in Patients with Detrusor Hyperactivity and Impaired Contractility.
abstract: We investigated the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with detrusor hyperactivity and impaired contractility (DHIC). Twenty-one patients with urodynamically proven DHIC and 21 age-matched patients with overactive bladder (OAB) with urodynamic detrusor overactivity were treated with intravesical injections of 100 U of onabotulinumtoxinA. The overactive bladder symptom score, urgency severity score, patient perception of bladder condition, global response assessment, voiding diary, and procedure-related adverse events (AE) at baseline, two weeks, one, three, and six months after treatment were assessed. The results showed that the subjective symptom scores improved significantly in both groups, and the scores did not differ between the groups. The decrease in urgency episodes and urgency urinary incontinence were noted in OAB patients but not in DHIC patients. Although the incidence of AEs was comparable between the groups, the therapeutic efficacy lasted for a mean of 4.9 ± 4.8 months in DHIC patients and 7.2 ± 3.3 months in OAB patients (p = 0.03). We concluded that the efficacy of intravesical onabotulinumtoxinA injection for DHIC patients was limited and short-term. Nevertheless, AEs did not increase in DHIC. Intravesical onabotulinumtoxinA might not be a good indication in patients with DHIC and high post-voiding residual urine. Physicians should inform patients of the potential benefits and risks of onabotulinumtoxinA injection for treatment of DHIC.
authors.affiliation: Department of Urology, En Chu Kong Hospital, College of Medicine, National Taiwan University, Taipei 23702, Taiwan. ericwcc@ms27.hinet.net.|Department of Biomedical Engineering, Chung Yuan Christian University, Chung-Li 32023, Taiwan. ericwcc@ms27.hinet.net.
authors.forename: Chung-Cheng
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital, and Tzu Chi University, Hualien 97002, Taiwan. chenglinglee@gmail.com.
authors.forename: Cheng-Ling
authors.initials: CL
authors.lastname: Lee
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital, and Tzu Chi University, Hualien 97002, Taiwan. hck@tzuchi.com.tw.
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009498:Neurotoxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000188:drug therapy*
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A
keywords: onabotulinumtoxinA; overactive bladder; underactive detrusor