Role of botulinum toxin-A in refractory idiopathic overactive bladder patients without detrusor overactivity

Background To evaluate the efficacy of intradetrusor botulinum toxin-A (BTX-A) in idiopathic overactive bladder patients (OAB) refractory to anti-muscarinic therapy, without detrusor overactivity (DOA) on urodynamics. Methods Patients with refractory idiopathic OAB without DOA on urodynamics were pr...

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Bibliographic Details
Published in:International urology and nephrology 2012-02, Vol.44 (1), p.91-97
Main Authors: Kanagarajah, Prashanth, Ayyathurai, Rajinikanth, Caruso, Daniel J., Gomez, Christopher, Gousse, Angelo E.
Format: Article
Language:English
Subjects:
Adult
Aged
Botulinum Toxins, Type A - administration & dosage
Botulinum Toxins, Type A - therapeutic use
Female
Humans
Injections, Intramuscular
Male
Medicine
Medicine & Public Health
Middle Aged
Muscarinic Antagonists - therapeutic use
Muscle, Smooth - physiology
Nephrology
Neuromuscular Agents - administration & dosage
Neuromuscular Agents - therapeutic use
Prospective Studies
Quality of Life
Statistics, Nonparametric
Surveys and Questionnaires
Treatment Failure
Urinary Bladder, Overactive - complications
Urinary Bladder, Overactive - drug therapy
Urinary Bladder, Overactive - physiopathology
Urinary Incontinence, Urge - etiology
Urodynamics
Urology
Urology – Original Paper
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Summary:Background To evaluate the efficacy of intradetrusor botulinum toxin-A (BTX-A) in idiopathic overactive bladder patients (OAB) refractory to anti-muscarinic therapy, without detrusor overactivity (DOA) on urodynamics. Methods Patients with refractory idiopathic OAB without DOA on urodynamics were prospectively enrolled. Subjects completed a 3-day voiding diary (3-VD), urogenital distress inventory-6 questionnaire (UDI-6) and graded their quality of life on a 10-cm visual analog scale (VAS) prior to study enrollment and at week 12 postinjection. All patients underwent multichannel urodynamics at study enrollment and 12 weeks postinjection. Improvement was analyzed based on 3-VD, UDI-6 questionnaire, VAS scores, and urodynamic parameters at week 12 postinjection compared to study enrollment. Results The study included 32 patients. Mean ± SD age was 56 ± 16. There were 27 women and 5 men. Nineteen patients had OAB without incontinence (OAB-dry) and 13 patients had OAB with incontinence (OAB-wet). In OAB-dry patients, mean ± SD urinary frequency dropped from 24 ± 11 to 10 ± 4 by week 12. In OAB-wet patients, mean ± SD urge incontinence episodes dropped from 7.9 ± 5 to 0 ± 2.6 by week 12. Mean UDI-6 and VAS scores improved significantly in both groups by week 12 ( P  = 0.0001). On comparing urodynamic parameters, OAB-wet patients showed significant decrease in maximum detrusor pressure during the voiding phase at week 12 compared to baseline values ( P  = 0.02). Conclusions Refractory idiopathic OAB patients without DOA on urodynamics may benefit from intradetrusor BTX-A.
ISSN:0301-1623
1573-2584
DOI:10.1007/s11255-011-9979-9