Experience With 100 Cases Treated With Botulinum-A Toxin Injections in the Detrusor Muscle for Idiopathic Overactive Bladder Syndrome Refractory to Anticholinergics
Abstract
Purpose:
In this prospective, nonrandomized, ongoing study we evaluated the efficacy and safety of botulinum-A toxin injections in the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment, such as anticholinergic drugs.
Materials and Methods:
A total of 23 men and 77 women with a mean age of 63 years (range 24 to 89) with nonneurogenic overactive bladder, including urgency-frequency syndrome, and incontinence despite the administration of maximal doses of anticholinergics were consecutively treated with injections of 100 U botulinum-A toxin in the detrusor muscle at 30 sites under cystoscopic guidance. Micturition diary, full urodynamics, neurological status and urine probes were performed in all participants before treatment. Bladder biopsies were done only in cases of suspected bladder fibrosis or unclear findings. Special attention was given to reflex volume, maximal bladder capacity, detrusor compliance, post-void residual urine, urgency and frequency/nocturia. Clinical, urodynamic and quality of life assessments were performed at baseline, and 4, 12 and 36 weeks after botulinum-A toxin treatment.
Results:
Overall after 4 and 12 weeks 88% of our patients showed significant improvement in bladder function in regard to subjective symptoms, quality of life and urodynamic parameters (p <0.001). Urgency disappeared in 82% of the patients and incontinence resolved in 86% within 1 to 2 weeks after botulinum-A toxin injections. Mean frequency decreased from 14 to 7 micturitions daily (−50%) and nocturia decreased from 4 to 1.5 micturitions. Mean maximal bladder capacity increased 56% from 246 to 381 ml, mean detrusor compliance increased from 24 to 41 ml/cm H2O and pretreatment detrusor instability (mean reflex volume 169 ml) resolved in 74% of patients. Mean volume at first desire to void increased from 126 to 212 ml and mean urge volume increased from 214 to 309 ml. There were no severe side effects except temporary urine retention in 4 cases. Only in 8 patients was the clinical benefit poor and analysis revealed preoperative low detrusor compliance. Mean efficacy duration ± SD was at least approximately 6 ± 2 months and then symptoms began to increase.
Conclusions:
Our results show that intradetrusor botulinum-A toxin injections may be an efficient and safe treatment option in patients with severe overactive bladder resistant to all conventional treatments.
References
- 1 : The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn2002; 21: 167. Google Scholar
- 2 : Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients. J Urol1996; 155: 1023. Link, Google Scholar
- 3 : Intrasphincteric injection of botulinum toxin is effective in long-term treatment of esophageal achalasia. Muscle Nerve1998; 21: 1540. Google Scholar
- 4 : Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol2000; 164: 692. Link, Google Scholar
- 5 : Botulinum toxin A has antinociceptive effects in treating interstitial cystitis. Urology2004; 64: 871. Google Scholar
- 6 : Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol2005; 174: 977. Link, Google Scholar
- 7 : Good urodynamic practices: uroflowmetry, filling cystometry and pressure-flow studies. Neurourol Urodyn2002; 21: 261. Google Scholar
- 8 : Multinational study of reliability and validity of the King’s Health Questionnaire in patients with overactive bladder. Qual Life Res2003; 12: 427. Google Scholar
- 9 : Efficacy of botulinum-a toxin in children with detrusor hyperreflexia due to meningomyelocele: preliminary results. Urology2002; 59: 325. Google Scholar
- 10 : Effect of botulinum toxin A on the autonomic nervous system of the rat lower urinary tract. J Urol2003; 169: 1896. Link, Google Scholar
- 11 : The effect of botulinum-A toxin on patients with severe urge urinary incontinence. J Urol2004; 172: 2316. Link, Google Scholar
- 12 : Treatment of overactive bladder with botulinum toxin B: a pilot study. Int Urogynecol J Pelvic Floor Dysfunct2003; 14: 424. Google Scholar
- 13 : Use of botulinum-A toxin for the treatment of refractory overactive bladder symptoms: an initial experience. Urology2004; 63: 1071. Google Scholar
- 14 : Urodynamic evidence of effectiveness of botulinum A toxin injection in treatment of detrusor overactivity refractory to anticholinergic agents. Urology2004; 63: 868. Google Scholar
- 15 : Botulinum toxin: a new dimension in the treatment of lower urinary tract dysfunction. Urology2004; 64: 2. Google Scholar
- 16 : Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy. Headache2004; 44: 35. Google Scholar
- 17 : Botulinum toxin for palmar hyperhydrosis. Lancet1997; 349: 252. Google Scholar
- 18 : Motor responses of the urinary bladder and skeletal muscle in botulinum intoxicated rats. J Physiol1967; 188: 1. Google Scholar
- 19 : Presynaptic action of botulinal neurotoxins at vertebrate neuromuscular junction. J Physiol1990; 84: 152. Google Scholar
- 20 : Motor nerve sprouting in human orbicularis muscle after botulinum A injections. Invest Ophthalmol Vis Sci1990; 31: 964. Google Scholar
- 21 : Lack of ultrastructural detrusor changes following endoscopic injection of botulinum toxin type A in overactive neurogenic bladder. Eur Urol2004; 46: 784. Google Scholar
- 22 : Effect of volume and concentration on diffusion of botulinum exotoxin A. Arch Dermatol2004; 140: 1351. Google Scholar
