Abstract
Purpose
To test the efficacy, duration and safety of 100 U of botulinum toxin type A (BoNT/A) in women affected by idiopathic detrusor overactivity (IDO) and the effectiveness of subsequent injections.
Methods
In this double centre, prospective study conducted from March 2008 to March 2010, we selected women affected by IDO who failed to respond to various antimuscarinic agents, reported intolerable anticholinergic side-effects or contraindication to their use, also without any response to tibial stimulation. Medical history, physical examination, standard urodynamic examination, urinalysis, urine culture, a 4-day voiding diary and a quality of life questionnaire were requested for all patients. A total amount of 100 U of BoNT/A were injected into the detrusor muscle. A second injection of BoNT/A was suggested to patients who experienced a relapse of initially improved symptoms.
Results
We enrolled a total number of 68 women. All patients showed significant improvement in urodynamic parameters, clinical features and quality of life, after the first injection of Botox® until the 9 months of follow-up. Even after the second injection, with a follow-up of 3 months, we obtained results comparable with the first injection. Side-effects include an increase in post-void residual volume, dysuria and urinary infections.
Conclusions
We considered the dose of 100 U of Botox®, for treatment of IDO, as an efficacious and safe solution compared to other therapeutic options, without serious and lasting adverse effects for women, even after a second injection.
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References
van Ermengem E (1979) Classics in infectious diseases: a new anaerobic bacillus and its relation to botulism. Rev Infect Dis 1:701–719
Sahai A, Dowson C, Khan MS et al (2009) Improvement in quality of life after botulinum toxin-A injections for idiopathic detrusor overactivity: results from a randomized double-blind placebo-controlled trial. BJU Int 103:1509–1515
O’Brien CF (2002) Treatment of spasticity with botulinum toxin. Clin J Pain 18:S182–S190 (Review)
Stöhrer M, Wolff A, Kramer G et al (2007) Seven years of botulinum toxin type A in the treatment of neurogenic detrusor hyperactivity. Urologe A 46:1211–1218
Schmid DM, Roy S, Sulser T (2008) Prospects and limitations of treatment with botulinum neurotoxin type A for patients with refractory idiopathic detrusor overactivity. BJU Int 1:7–10
Apostolidis A, Dasgupta P, Fowler CJ (2006) Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur Urol 49:644–650 (Review)
Mohanty NK, Nayak RL, Alam M (2008) Role of botulinum toxin-A in management of refractory idiopathic detrusor overactive bladder: single center experience. Indian J Urol 24:182–185
de Groat WC (2004) The urothelium in overactive bladder: passive bystander or active participant? Urology 64:7–11 (Review)
Chopra B, Barrick SR, Meyers S et al (2005) Expression and function of bradykinin B1 and B2 receptors in normal and inflamed rat urinary bladder urothelium. J Physiol 562:859–871
De Sèze M, Ruffion A, Haab F et al (2008) Patient follow-up after botulinum toxin intradetrusor injection: proposal for management in neurogenic patients. Ann Readapt Med Phys 51:315–321
Abrams P, Cardozo L, Fall M et al (2002) Standardisation Sub-committee of the International Continence Society: the standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178
Wagner TH, Patrick DL, Bavendam TG, Martin ML, Buesching DP (1996) Quality of life of persons with urinary incontinence: development of a new measure. Urology 147:67–71 (Discussion 71–72)
Gamé X, Mouracade P, Chartier-Kastler E et al (2009) Botulinum toxin-A (Botox) intradetrusor injections in children with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review. J Pediatr Urol 5:156–164
Brubaker L, Richter HE, Visco A et al (2008) Pelvic floor disorders network: refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol 180:217–222
Kessler TM, Khan S, Panicker J, Roosen A, Elneil S, Fowler CJ (2009) Clean intermittent self-catheterization after botulinum neurotoxin type A injections: short-term effect on quality of life. Obstet Gynecol 113:1046–1051
Mehnert U, Schurch B (2009) Botulinum toxin in nonneurogenic bladder dysfunction. Urologe A 48:233–244
Apostolidis A, Jacques TS, Freeman A et al (2008) Histological changes in the urothelium and suburothelium of human overactive bladder following intradetrusor injections of botulinum neurotoxin type A for the treatment of neurogenic or idiopathic detrusor overactivity. Eur Urol 53:1245–1253
Giannantoni A, Di Stasi SM, Stephen RL, Bini V, Costantini E, Porena M (2004) Intravesical resiniferatoxin versus botulinum-A toxin injections for neurogenic detrusor overactivity: a prospective randomized study. J Urol 172:240–243
Kessler TM, Khan S, Panicker JN et al (2010) In the human urothelium and suburothelium, intradetrusor botulinum neurotoxin type A does not induce apoptosis: preliminary results. Eur Urol 57:879–883
Schurch B, Stöhrer M, Kramer G, Schmid DM, Gaul G, Hauri D (2000) Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 164:692–697
Reitz A, Stöhrer M, Kramer G et al (2004) European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 45:510–515
Grosse J, Kramer G, Stöhrer M (2005) Success of repeat detrusor injections of botulinum a toxin in patients with severe neurogenic detrusor overactivity and incontinence. Eur Urol 47:653–659
Schmid DM, Sauermann P, Werner M et al (2006) Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics. J Urol 176:177–185
Kalsi V, Apostolidis A, Gonzales G, Elneil S, Dasgupta P, Fowler CJ (2008) Early effect on the overactive bladder symptoms following botulinum neurotoxin type A injections for detrusor overactivity. Eur Urol 54:181–187
Kalsi V, Apostolidis A, Popat R, Gonzales G, Fowler CJ, Dasgupta P (2006) Quality of life changes in patients with neurogenic versus idiopathic detrusor overactivity after intradetrusor injections of botulinum neurotoxin type A and correlations with lower urinary tract symptoms and urodynamic changes. Eur Urol 49:528–535
Schurch B, de Sèze M, Denys P, Botox Detrusor Hyperreflexia Study Team et al (2005) 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 Urol 174:196–200
Schurch B, Denys P, Kozma CM, Reese PR, Slaton T, Barron RL (2007) Botulinum toxin A improves the quality of life of patients with neurogenic urinary incontinence. Eur Urol 52:850–858
White WM, Pickens RB, Doggweiler R, Klein FA (2008) Short-term efficacy of botulinum toxin a for refractory overactive bladder in the elderly population. J Urol 180:2522–2526
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Granese, R., Adile, G., Gugliotta, G. et al. Botox® for idiopathic overactive bladder: efficacy, duration and safety. Effectiveness of subsequent injection. Arch Gynecol Obstet 286, 923–929 (2012). https://doi.org/10.1007/s00404-012-2349-8
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DOI: https://doi.org/10.1007/s00404-012-2349-8