Short-Term Efficacy of Botulinum Toxin A for Refractory Overactive Bladder in the Elderly Population
is accompanied by
Abstract
Purpose:
We determined the efficacy of intravesical botulinum toxin A injection for refractory overactive bladder in elderly patients.
Materials and Methods:
Patients 75 years or older with refractory urinary urgency were prospectively evaluated and offered treatment of symptoms with botulinum toxin A. A voiding log was obtained and urodynamics were performed before treatment. Patients underwent injection of 200 U botulinum toxin A (Botox®) into the detrusor muscle at 20 sites under cystoscopic guidance. Patients were followed postoperatively for evidence and duration of success, and treatment related complications.
Results:
From January 2006 to June 2007, 18 females and 3 males with a mean age of 81.2 years (range 75 to 92) in whom detrusor overactivity was confirmed on urodynamics and who were refractory to or intolerant of antimuscarinics were treated with intravesical botulinum toxin A. Preoperatively the mean ± SD number of daily voids was 11.4 ± 1.67 and the mean number of pads per day was 4.0 ± 0.89. One month after treatment 16 of the 21 patients (76%) reported greater than 50% improvement in symptoms after 1 injection. Specifically there was a significant improvement in the mean number of voids per day (5.19 ± 0.83, p <0.001) and in the number of pads used daily (1.3 ± 0.60, p <0.001). Two of the remaining 5 patients demonstrated greater than 50% improvement following repeat injection, while 3 did not show improvement after 2 injections. Mean time to deterioration was 7.12 months. There were no treatment related complications.
Conclusions:
Intravesical botulinum toxin A for detrusor overactivity in the elderly population appears to be efficacious and durable. Given its low incidence of adverse events, it should be considered a viable treatment option in this population.
References
- 1 : Behavioral therapy for overactive bladder. Urology2000; 55: 3. Crossref, Medline, Google Scholar
- 2 : Management of overactive bladder. N Engl J Med2004; 350: 786. Google Scholar
- 3 : Extended-release formulations of oxybutynin and tolterodine exhibit similar central nervous system tolerability profiles: a subanalysis of data from the OPERA trial. Am J Obstet Gynecol2005; 192: 1849. Google Scholar
- 4 :
Electrical stimulation for storage and emptying disorders . In: Campbell-Walsh Urology. Edited by . Philadelphia: WB Saunders2007: 2147. vol 3, chapt 64. Google Scholar - 5 : 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
- 6 : Experience with 100 cases treated with botulinum-A toxin injection in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics. J Urol2006; 176: 177. Link, Google Scholar
- 7 : Comparison of effectiveness of detrusor, suburothelial, and bladder base injections of botulinum toxin a for idiopathic detrusor overactivity. J Urol2007; 178: 1359. Link, Google Scholar
- 8 Schurch B, Hauri D, Rodic B, Curt A, Meyer M and Rossier AB: Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients. Google Scholar
- 9 : Botulinum toxin type A is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol2005; 174: 196. Link, Google Scholar
- 10 : Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra. Urology2005; 65: 37. Google Scholar
- 11 : Do repeat intradetrusor botulinum toxin type a injections yield valuable results? Clinical and urodynamic results after five injections in patients with neurogenic detrusor overactivity. Eur Urol2007; 52: 1729. Google Scholar
- 12 : Neurogenic detrusor overactivity treated with English botulinum toxin A: 8-year experience of one single centre. Eur Urol2008; 53: 1013. Google Scholar
- 13 : Botulinum toxin A in the overactive bladder: current status and future directions. BJU Int2007; 99: 247. Google Scholar
- 14 : Botulinum toxin for the management of bladder dysfunction. Drugs2006; 66: 1301. Google Scholar
- 15 : Botulinum injections for the treatment of bladder symptoms of multiple sclerosis. Ann Neurol2007; 62: 452. Google Scholar
- 16 : Efficacy and complications of intradetrusor injection with botulinum toxin A in patients with refractory idiopathic detrusor overactivity. BJU Int2007; 100: 1302. Google Scholar
- 17 : Botulinum toxin A improves quality of life of patients with neurogenic urinary incontinence. Eur Urol2007; 52: 850. Google Scholar
Division of Urologic Surgery, University of Tennessee Medical Center, Knoxville, Tennessee
