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Kuo HC. Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A. Tzu Chi Med J 2024; 36:260-270. [PMID: 38993829 PMCID: PMC11236072 DOI: 10.4103/tcmj.tcmj_29_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 07/13/2024] Open
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with central nervous system (CNS) lesions. Cases of cerebrovascular accidents (CVA), Parkinson's disease, dementia, and other intracranial lesions develop poor bladder control with or without urinary difficulty due to loss of cortical perception of bladder filling sensation and poor coordination of urethral sphincter relaxation during reflex micturition. Patients with CNS lesions usually have overactive bladder (OAB) symptoms, including urgency, frequency, incontinence, voiding symptoms of dysuria, large postvoid residual volume, and retention. In elderly patients with severe CNS disease the OAB symptoms are usually difficult to adequately relieve by medical treatment, and thus, their quality of life is greatly. Botulinum toxin A (BoNT-A) is currently licensed and has been applied in patients with idiopathic and neurogenic OAB due to spinal cord injury or multiple sclerosis. However, the application of BoNT-A in the treatment of urinary incontinence due to NLUTD in chronic CNS lesions has not been well-documented. Although cohort studies and case series support BoNT-A treatment for neurogenic OAB, chronic urine retention after intravesical BoNT-A injection for OAB and exacerbated urinary incontinence after urethral BoNT-A injection for voiding dysfunction have greatly limited its application among patients with NLUTD due to CNS lesions. This article reviews the pathophysiology and clinical characteristics of NLUTD in patients with CNS lesions and the clinical effects and adverse events of BoNT-A injection for patients with NLUTD. A flowchart was created to outline the patient selection and treatment strategy for neurogenic OAB.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Werneburg GT, Stoffel JT. Bladder Compliance: How We Define It and Why It Is Important. Urol Clin North Am 2024; 51:209-220. [PMID: 38609193 DOI: 10.1016/j.ucl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Bladder compliance is the relationship between detrusor pressure and bladder storage volume. We discuss the definition of compliance, how it may be accurately measured, and its clinical relevance. Specifically, we discuss the association between low compliance and upper urinary tract deterioration. We discuss medical and surgical therapies that have been demonstrated to improve compliance and reduce upper tract risk. Finally, we propose a model, which not only considers compliance but also differential pressure between the bladder and ureters, and how this may also be an accurate predictor of upper tract deterioration. We call for further investigation to test this model.
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Affiliation(s)
- Glenn T Werneburg
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - John T Stoffel
- Department of Urology, Neurourology and Pelvic Reconstruction Division, University of Michigan, 3875 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Heuer CW, Gisseman JD, Vaccaro CM, Olsen CH, Galgano AC, Dengler KL. Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:272-279. [PMID: 38484242 DOI: 10.1097/spv.0000000000001466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Urinary tract infections (UTIs) occur in 8.6% to 48.1% of patients after intradetrusor onabotulinumtoxinA injections. OBJECTIVE The objective of this study was to evaluate both choice and duration of antibiotic prophylaxis on the incidence of UTI within 30 days after in-office onabotulinumtoxinA injections. STUDY DESIGN We included a single-site, retrospective cohort of 305 patients with overactive bladder or bladder pain syndrome receiving postprocedure prophylactic antibiotics for in-office, 100-unit intradetrusor onabotulinumtoxinA injections from 2019 to 2023. Categories of antibiotic prophylaxis compared included (1) nitrofurantoin 100 mg twice daily for 3 days, (2) nitrofurantoin 100 mg twice daily for 5 days, (3) trimethoprim-sulfamethoxazole 160 mg/800 mg twice daily for 3 days, and (4) "other regimens." Primary outcome was incidence of UTI within 30 days. Variables were compared via χ2 test. Crude/adjusted odds were estimated using binary logistic regression. RESULTS Incidence of UTI was 10.4% for 3-day nitrofurantoin, 20.5% for 5-day nitrofurantoin, 7.4% for 3-day trimethoprim-sulfamethoxazole, and 25.7% among "other regimens" (P = 0.023). Differences among primary regimens were substantial but not statistically significant: 3-day trimethoprim-sulfamethoxazole had 31% lower odds of UTI versus 3-day nitrofurantoin (odds ratio [OR], 0.689; P = 0.518). Compared with 3-day nitrofurantoin regimen, the 5-day nitrofurantoin regimen had twice the odds of UTI (OR, 2.22; P = 0.088). Those receiving "other regimens" had nearly 3 times the odds of UTI (OR, 2.98; P = 0.018). Results were similar adjusting for age and race. Overall urinary retention rate was 1.97%. CONCLUSIONS Prophylactic antibiotic choice and duration of treatment potentially affect UTI incidence after in-office, intradetrusor onabotulinumtoxinA injections. Nitrofurantoin and trimethoprim-sulfamethoxazole for 3 days have the lowest UTI incidence.
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Affiliation(s)
- Christopher W Heuer
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
| | - Jordan D Gisseman
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
| | - Christine M Vaccaro
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
| | - Cara H Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD
| | - Alissa C Galgano
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
| | - Katherine L Dengler
- From the Urogynecology Division, Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center
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Therapeutic Effect of Botulinum Toxin A on Sensory Bladder Disorders-From Bench to Bedside. Toxins (Basel) 2020; 12:toxins12030166. [PMID: 32182780 PMCID: PMC7150911 DOI: 10.3390/toxins12030166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 12/22/2022] Open
Abstract
Bladder oversensitivity arises from several different conditions involving the bladder, bladder outlet, systemic or central nervous system diseases. Increase of the bladder sensation results from activation of the sensory receptors in the urothelial cells or suburothelial tissues. Medical treatment targeting the overactive bladder (OAB) or interstitial cystitis (IC) might relieve oversensitive bladder symptoms (frequency, urgency and pain) in a portion of patients, but a certain percentage of patients still need active management. Botulinum toxin A (BoNT-A) has been demonstrated to have anti-inflammatory and antinociceptive effects in bladder sensory disorders and has been shown effective in the reduction of bladder oversensitivity and the increase of functional bladder capacity. For patients with OAB, urgency and urinary incontinence improved, while in patients with IC, bladder pain could be relieved in association with reduction of bladder oversensitivity after BoNT-A intravesical injection. Histological evidence has confirmed the therapeutic mechanism and clinical efficacy of intravesical BoNT-A injection on patients with OAB or IC. Bladder oversensitivity can also be relieved with the instillation of liposome encapsulated BoNT-A or low energy show waves (LESWs), which enable the BoNT-A molecule to penetrate into the urothelium and suburothelial space without affecting the detrusor contractility. Liposome encapsulated BoNT-A or combined LESWs and BoNT-A instillation might be future treatment alternatives for bladder oversensitivity in sensory bladder disorders.
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Gong QQ, Xu YQ, Xu J, Ding XY, Guo C. Meta-Analysis of Randomized Controlled Trials Using Botulinum Toxin A at Different Dosages for Urinary Incontinence in Patients With Overactive Bladder. Front Pharmacol 2020; 10:1618. [PMID: 32009968 PMCID: PMC6974921 DOI: 10.3389/fphar.2019.01618] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/11/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Urinary incontinence (UI) is a common and refractory complication for patients with neurogenic detrusor overactivity (NDO) or idiopathic overactive bladder (IOAB). Objectives: To evaluate the effect of Botulinum toxin A (BTX-A) based on different dosages strategy for UI. Method: The MEDLINE, Ovid EMbase, The Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Internet (CNKI), and WanFang database were searched for relevant published randomized controlled trials (RCTs) between 1969 to September 31, 2018. All database were searched to identify relevant randomized controlled trials (RCTs) that investigated the clinical benefit of BTX-A for management of UI in patients with NDO and IOAB. Results: This meta-analysis involved 19 original studies. The BTX-A was superior to placebo in reducing episodes of UI for NDO patients in all subgroups of different dosages for different durations, and also reduced maximum detrusor pressure in all kinds of 200U and 300U at 6 weeks. However, it increased post void residual in different dosages of 200U at 2 weeks. For IOAB patients, compared to placebo, BTX-A increased detrusor compliance for different dosages of 200U and 300U at 12 and 36 weeks, but it increased risk of urinary tract infections at other dosages. Conclusions: This meta-analysis indicated that BTX-A 200U and 300U are more effective than placebo in the treatment of NDO, with minimal, local, and manageable adverse events. Furthermore, BTX-A 300U and 200U could also improve detrusor compliance of IOAB. However, more RCTs would still be necessary to explore the effect of BTX-A on management of UI in NDO and IOAB patients.
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Affiliation(s)
- Qin-Qin Gong
- Center for Women's Healthcare Sciences, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yu-Qiong Xu
- Department of Gynaecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun Xu
- Center for Gynaecology and Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xiao-Yan Ding
- Center for Gynaecology and Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Chong Guo
- Center for Women's Healthcare Sciences, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Center for Gynaecology and Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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Lucas E. Medical Management of Neurogenic Bladder for Children and Adults: A Review. Top Spinal Cord Inj Rehabil 2019; 25:195-204. [PMID: 31548786 PMCID: PMC6743750 DOI: 10.1310/sci2503-195] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurogenic bladder is a chronic condition affecting patients of all ages with significant medical and quality of life implications. Goals of treatment consist of protection of the upper urinary tract and promotion of reliable urinary continence. Successful management involves medications and most often bladder drainage via clean intermittent catheterization. This article reviews current literature on medical management to achieve goals of treatment.
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Sacco E, Paolillo M, Totaro A, Pinto F, Volpe A, Gardi M, Bassi P. Botulinum toxin in the treatment of overactive bladder. Urologia 2018. [DOI: 10.1177/039156030807500102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clinical effectiveness of botulinum toxin (BTX) in the treatment of both neurogenic and idiopathic detrusor overactivity has been demonstrated in several studies. However, different protocols and techniques have been used by authors. Methods. Literature review on intradetrusor injection of BTX for detrusor overactivity. Results. The greatest clinical experience reports the use of 200 and 300 U Botox®. Available data suggest that clinical efficacy, duration, and the side effect profile is similar at these doses. Very few data, on the other hand, are available regarding the clinical outcomes using the Dysport® preparation; isolated reports support that efficacy is similar when using a dosing range of 500 to 1000 SU with increased risk of systemic side effects using 1000 SU. A variety of injection volumes was used, demonstrating similar efficacy and tolerability profile. Clinical effect duration extends six to ten months in the majority of studies. Data suggest that a repeated injection scheme proves successful in the vast majority of initial responders. Conclusions. Safety, effectiveness, specificity and reversibility make BTX a new attractive treatment modality for overactive bladder syndrome. However, more experience is needed to standardize the injection protocol with respect to therapeutic outcomes and adverse effects.
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Affiliation(s)
- E. Sacco
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma
| | - M. Paolillo
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma
| | - A. Totaro
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma
| | - F. Pinto
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma
| | - A. Volpe
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma
| | - M. Gardi
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma
| | - P.F. Bassi
- Urologia, Policlinico Universitario “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma
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Clinical and Urodynamic Results of Repeated Intradetrusor Onabotulinum Toxin A Injections in Refractory Neurogenic Detrusor Overactivity: Up to 5 Injections in a Cohort of Children With Myelodysplasia. Urology 2017; 111:168-175. [PMID: 28943369 DOI: 10.1016/j.urology.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of repeated intradetrusor onabotulinum toxin A (onaBoNT-A) injections in children with neurogenic detrusor overactivity due to myelodysplasia. MATERIALS AND METHODS The study group consisted of 19 children (4 boys and 15 girls) with a mean age of 10.3 ± 3.1 years old, who had received at least 2 injections of 10 U/kg onaBoNT-A for the treatment of urinary incontinence resistant to anticholinergic treatment and clean intermittent catheterization in our clinic, between 2010 and 2015. Controlled urodynamic studies were performed at the baseline and 3 months after each injection. RESULTS Eight of the children received 3 injections, 5 children had 4 injections, and 2 children had 5 injections. From the baseline to the fifth injection, the detrusor compliance (1.3, 4.5, 10, 20.7, 18.8, and 16.6 mL/cm H2O), the maximum bladder capacity (82.0, 157.0, 191.0, 272.0, 299.0, and 210.5 mL), and the maximum detrusor pressure (55.0, 33.0, 22.0, 12.5, 16.0, and 12.5 cm H2O) were assessed. The findings significantly improved following the first, second, and third injections, when compared with the previous bladder dynamics (P <.05), but the differences with the fourth were not statistically significant (P >.05). The continence periods were similar under clean intermittent catheterization after all of the injections (P <.05), and no severe side effects were observed. CONCLUSION Repeated onaBoNT-A injections are a safe treatment modality and can be offered as an effective alternative choice, instead of more invasive surgery, in children with neurogenic detrusor overactivity due to myelodysplasia.
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Gu HY, Song JK, Zhang WJ, Xie J, Yao QS, Zeng WJ, Zhang C, Niu YM. A systematic review and meta-analysis of effectiveness and safety of therapy for overactive bladder using botulinum toxin A at different dosages. Oncotarget 2017; 8:90338-90350. [PMID: 29163833 PMCID: PMC5685754 DOI: 10.18632/oncotarget.20056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the effectiveness and safety of botulinum toxin A (BTX-A) at different dosages for overactive bladder (OAB). Materials and Methods The MEDLINE, EMBASE, and Cochrane Controlled Trials Register databases were searched through November 3, 2016 to identify relevant randomized controlled trials (RCTs). Results Eleven studies were identified in this meta-analysis. Compared with placebo, the urinary incontinence (UI) episodes per week as the primary outcomes, urodynamic parameters including maximum cystometric capacity (MCC), and maximum detrusor pressure (MDP) for neurogenic detrusor overactivity (NDO) at 6 weeks, and for idiopathic detrusor overactivity (IDO) at 36 weeks were evaluated. These and other outcomes for effectiveness of BTX-A at different dosages in two observation periods indicate that a dose greater than 50 U is significantly more effective for certain symptoms of OAB compared with placebo. However, there were no significant differences between some dosages. Compared with placebo, the outcomes of total adverse events for NDO and for IDO show that doses of 300 U and 200 U for NDO are associated with more complications. Conclusions In consideration that the treatments of BTX-A were with minimal, local, and manageable adverse effects, this meta-analysis demonstrates that BTX-A 200 U is recommended for management of NDO for short-term treatment for there was no significant difference from the larger dose of 300U. The short-term efficacies of BTX-A for IDO remain to be investigated.
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Affiliation(s)
- Hui-Yun Gu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Ju-Kun Song
- Department of Oral and Maxillary Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Wen-Jun Zhang
- Department of Ultrasound, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Jin Xie
- Administrative Office, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Qi-Sheng Yao
- Department of Urinary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Wen-Jing Zeng
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Yu-Ming Niu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China.,Department of Urinary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
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Freemantle N, Khalaf K, Loveman C, Stanisic S, Gultyaev D, Lister J, Drake M. OnabotulinumtoxinA in the treatment of overactive bladder: a cost-effectiveness analysis versus best supportive care in England and Wales. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:911-921. [PMID: 26482712 DOI: 10.1007/s10198-015-0737-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/29/2015] [Indexed: 06/05/2023]
Abstract
The cost-effectiveness of onabotulinumtoxinA (BOTOX(®)) 100 U + best supportive care (BSC) was compared with BSC alone in the management of idiopathic overactive bladder in adult patients who are not adequately managed with anticholinergics. BSC included incontinence pads and, for a proportion of patients, anticholinergics and/or occasional clean intermittent catheterisation. A five-state Markov model was used to estimate total costs and outcomes over a 10-year period. The cohort was based on data from two placebo-controlled trials and a long-term extension study of onabotulinumtoxinA. After discontinuation of initial treatment, a proportion of patients progressed to downstream sacral nerve stimulation (SNS). Cost and resource use was estimated from a National Health Service perspective in England and Wales using relevant reference sources for 2012 or 2013. Results showed that onabotulinumtoxinA was associated with lower costs and greater health benefits than BSC in the base case, with probabilistic sensitivity analysis indicating an 89 % probability that the incremental cost-effectiveness ratio would fall below £20,000. OnabotulinumtoxinA remained dominant over BSC in all but two scenarios tested; it was also economically dominant when compared directly with SNS therapy. In conclusion, onabotulinumtoxinA appears to be a cost-effective treatment for overactive bladder compared with BSC alone.
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Affiliation(s)
- Nick Freemantle
- Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.
| | - Kristin Khalaf
- Allergan Inc., 2525 Dupont Drive, Irvine, CA, 92612-1599, USA
| | - Clara Loveman
- Allergan Holdings Ltd., Marlow International, The Parkway, Marlow, SL7 1YL, UK
| | - Sanja Stanisic
- LA-SER ANALYTICA, Corso di Porta Nuova 34, Milan, 20121, Italy
| | | | - Johanna Lister
- LA-SER ANALYTICA, Meeraner Platz 1, Lörrach, 79539, Germany
| | - Marcus Drake
- School of Clinical Sciences and Bristol Urological Institute, University of Bristol, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK
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Abdelwahab O, Sherif H, Soliman T, Elbarky I, Eshazly A. Efficacy of botulinum toxin type A 100 Units versus 200 units for treatment of refractory idiopathic overactive bladder. Int Braz J Urol 2016; 41:1132-40. [PMID: 26742971 PMCID: PMC4756939 DOI: 10.1590/s1677-5538.ibju.2014.0221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the efficacy and safety of a single intra detrusor injection of BoNTA comparing two different doses (100 U or 200 U) in patients with idiopathic overactive bladder. Materials and Methods: A randomized prospective study evaluated the efficacy of BoNTA in management of refractory idiopathic overactive bladder and included 80 patients. All patients were assessed initially by taking a history, a physical examination, overactive bladder symptom score, urine analysis, routine laboratory investigations, KUB and pelviabdominal. OABSS was adjusted on all patients postoperative at 1,3,6,9 months also Urodynamic was done for all patients preoperative and postoperative at 3, 6, 9 months. Results: The mean age was 30.22±8.37 and 31.35±7.61 in group I and II respectively. There was no statistically difference between both groups in all parameters all over the study except at 9 months after treatment. Hematuria was observed 6 and 9 patients in group I and II respectively. Dysuria was observed in 6 and 15 patients in group I and II respectively. UTI was detected in 3 and 7 patients in group I and II respectively. Conclusion: A single-injection procedure of 100 U or 200 U BoNTA is an effective and safe treatment for patients with IOAB who failed anticholinergic regimens. OABSS and QoL were improved for 6 months; 100 U injections seemed to have comparable results with 200 U. There was a significant difference at month 9 towards 200 U with more incidences of adverse events.
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Affiliation(s)
- Osama Abdelwahab
- Urology department, Faculty of Medicine, Benha University, Egypt
| | - Hammouda Sherif
- Urology department, Faculty of Medicine, Benha University, Egypt
| | - Tark Soliman
- Urology department, Faculty of Medicine, Benha University, Egypt
| | - Ihab Elbarky
- Urology department, Faculty of Medicine, Benha University, Egypt
| | - Aly Eshazly
- Urology department, Faculty of Medicine, Benha University, Egypt
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12
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Hsiao SM, Lin HH, Kuo HC. Factors Associated with Therapeutic Efficacy of Intravesical OnabotulinumtoxinA Injection for Overactive Bladder Syndrome. PLoS One 2016; 11:e0147137. [PMID: 26824901 PMCID: PMC4732812 DOI: 10.1371/journal.pone.0147137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/16/2015] [Indexed: 01/22/2023] Open
Abstract
Objectives To analyze the predictors of therapeutic efficacy after intravesical botulinum toxin A injection for overactive bladder syndrome (OAB) refractory to antimuscarinic therapy. Methods All consecutively OAB patients, who visited the urologic outpatient clinics of a medical center and refractory to antimuscarinic treatment, were prospectively enrolled. All enrolled patients received intravesical injection of 100 U onabotulinumtoxinA (Botox). The Global Response Assessment (GRA) score ≥ 2 at 3 months after Botox injection was defined as a successful treatment, otherwise failed. Results Overall, 89 patients received intravesical injection. Eighty patients, including 42 men and 38 women, had received follow-up at 3 months. The overall success rate was 63.8%. The global response assessment, urgency severity score, urgency, urgency urinary incontinence and frequency episodes, and functional bladder capacity improved after treatment. However, post-void residual volume (PVR) increased, and voiding efficiency (VE) decreased after treatment. Female gender (odds ratio = 3.75) was the only independent factor associated with the success. Female gender (coefficient = 0.74), low baseline overactive bladder symptoms score (coefficient = -0.12) and the presence of OAB-wet (coefficient = 0.79) were independent factors associated with therapeutic efficacy (i.e., GRA score). VE (odds ratio = 0.062) was the only predictor for a large PVR at 3 months. The optimum cutoff value of VE was <87% with the area under the ROC curve being 0.64 (sensitivity = 63.8%, specificity = 57.1%). Conclusions The therapeutic effects of Botox can persist till 6 months after treatment. Female gender, low overactive bladder symptoms score and OAB-wet are associated better therapeutic efficacy, and low baseline VE is associated with large PVR. These findings can serve as an initial guide or assist in consultation regarding the treatment of OAB patients with Botox injection. Trial Registration ClinicalTrials.gov NCT01657409
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Affiliation(s)
- Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Banqiao, New Taipei, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- * E-mail:
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Patiño Sandoval GA, Sanchez Basto C, Iregui Parra JD, Fernández Bonilla JN. Guía vejiga hiperactiva no neurogénica en adultos. Guía de la Sociedad Colombiana de Urología. UROLOGÍA COLOMBIANA 2016. [DOI: 10.1016/j.uroco.2016.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kuo HC. OnabotulinumtoxinA Treatment for Overactive Bladder in the Elderly: Practical Points and Future Prospects. Drugs Aging 2015; 33:1-9. [PMID: 26666524 DOI: 10.1007/s40266-015-0335-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Overactive bladder (OAB) increases with age. OAB in the elderly may be associated with increased risks of falls, fractures and mortality. Degeneration of the central nervous system in the elderly is proposed as one of the pathogenic factors for OAB. Recently, onabotulinumtoxinA (BoNT-A) 100 U has been demonstrated to be well tolerated, and it significantly improves all OAB symptoms and health-related quality of life in patients who are inadequately managed with anticholinergics. However, an increased risk of a large post-void residual volume and a lower long-term success rate were noted in frail elderly patients. Careful patient selection for BoNT-A injection treatment is important in elderly OAB patients. Patients who are frail, are elderly, have comorbidity or have a post-void residual volume >100 mL should be monitored carefully after BoNT-A injection treatment to prevent urinary retention and subsequent urinary tract infection. Use of liposomes to carry BoNT-A across the urothelial barrier decreases urgency-frequency episodes without compromising detrusor contractility and might avoid urinary tract infection. This treatment might prevent undesired detrusor underactivity after BoNT-A injection treatment, especially in elderly patients who have low detrusor contractility. For treatment of OAB in the elderly, clinicians should be aware of the balance between therapeutic efficacy and safety.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707, Section 3, Chung Yang Road, Hualien, Taiwan.
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Jiang YH, Kuo HC. Reduction of urgency severity is the most important factor in the subjective therapeutic outcome of intravesical onabotulinumtoxinA injection for overactive bladder. Neurourol Urodyn 2015; 36:338-343. [DOI: 10.1002/nau.22925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/21/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
| | - Hann-Chorng Kuo
- Department of Urology; Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien Taiwan
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Jiang YH, Ong HL, Kuo HC. Predictive factors of adverse events after intravesical suburothelial onabotulinumtoxina injections for overactive bladder syndrome-A real-life practice of 290 cases in a single center. Neurourol Urodyn 2015; 36:142-147. [PMID: 26417884 DOI: 10.1002/nau.22892] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 09/15/2015] [Indexed: 12/13/2022]
Abstract
AIMS Patients often experience adverse events (AEs) after intravesical onabotulinumtoxinA (BoNT-A) treatment for overactive bladder refractory to antimuscarinic agents. We investigated the prevalence and predictive factors of AEs in such patients. METHODS A total of 290 patients underwent intravesical BoNT-A (100 U) suburothelial injection. The age, gender, overactive bladder subtypes, medical co-morbidities, and neurological diseases of the patients were recorded. The maximum flow rate (Qmax ), voided volume, post-void residual (PVR) volume, and voiding efficiency (VE) at baseline were analyzed to identify adverse events within 3 months after treatment. RESULTS Acute urinary retention (AUR) developed in 24 patients (8.3%), and urinary tract infection (UTI) occurred in 44 (15.2%) within 3 months of treatment. Large PVR volume (>200 ml) occurred in 81 (27.9%), 68 (24.3%), and 49 (18.4%) patients 1, 3, and 6 months after treatment, respectively. AUR developed significantly more often in men, patients >61 years old, those with a baseline Qmax ≤15 ml/sec, PVR ≥100 ml, and VE <90%. Patients older than 61 years had a higher incidence of large PVR 1 month after treatment. Female gender and a baseline PVR volume ≥100 ml had a greater incidence of UTI. Age >61 years, low Qmax , low voiding efficiency, and large PVR at baseline were also risk factors for adverse events. CONCLUSION AUR, UTI, and large PVR volume are common AEs after BoNT-A treatment. Patients with overactive bladders that are at risk of developing AEs after BoNT-A injection should be informed of the possible AEs. Neurourol. Urodynam. 36:142-147, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hueih-Ling Ong
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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Kuo HC. Botulinum Toxin A Injections for Non-neurogenic Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Léon P, Jolly C, Binet A, Fiquet C, Vilette C, Lefebvre F, Bouché-Pillon-Persyn MA, Poli-Mérol ML. Botulinum toxin injections in the management of non-neurogenic overactive bladders in children. J Pediatr Surg 2014; 49:1424-8. [PMID: 25148752 DOI: 10.1016/j.jpedsurg.2014.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 03/20/2014] [Accepted: 04/09/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Non-neurogenic detrusor overactivity in children leads to varying degrees of functional impairments (urinary urgency, pollakiuria, urge incontinence, nocturia). Botulinum toxin has shown its effectiveness in the management of detrusor overactivity in neurological patients. OBJECTIVES To evaluate the relevance of intravesical Botulinum toxin injections for the treatment of non-neurogenic overactive bladders in children. These pediatric patients were resistant to all the usual therapeutics (e.g. bladder/bowel rehabilitation, anticholinergic drugs, management of diet/hygiene habits and constipation, percutaneous posterior tibial nerve stimulation). MATERIALS AND METHODS 8 children (mean age: 12.5years), 5 girls, 3 boys with daytime and/or nighttime incontinence and non-neurogenic detrusor overactivity validated by urodynamic testing. Urodynamic testing was conducted before the injections as well as 6weeks and 1year post injections. We used Dysport® 8 Speywood Units/kg injected via cystoscopy into 25 different sites. RESULTS We noted improvements without any complaints during bladder voiding for all patients, in 6 patients the overactivity disappeared after 1 injection. Compliance was improved early-on in half the cases and at 1year for all cases (from 12% to 61%, p=0.01). Noninhibited contractions decreased constantly in both frequency and intensity. Clinical symptoms improved: mean of 7.75 daytime urinary incontinence episodes (IE) per week before the injection vs. 3 after the procedure (p=0.04). For nighttime IE the improvement was even more noticeable with 7.38 nighttime IE episodes per week before the injection vs. 2.06 after the procedure (p=0,02). CONCLUSION Intradetrusor Botulinum toxin injections are a potential therapeutic option for the management of non-neurogenic detrusor overactivity in children resistant to the usual treatments.
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Affiliation(s)
- Priscilla Léon
- Pediatric Surgery Department, American Hospital, CHU de Reims, France.
| | - Catherine Jolly
- Pediatric Surgery Department, American Hospital, CHU de Reims, France
| | - Aurélien Binet
- Pediatric Surgery Department, American Hospital, CHU de Reims, France
| | - Caroline Fiquet
- Pediatric Surgery Department, American Hospital, CHU de Reims, France
| | - Christine Vilette
- Pediatric Surgery Department, American Hospital, CHU de Reims, France
| | - Francis Lefebvre
- Pediatric Surgery Department, American Hospital, CHU de Reims, France
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Knuepfer S, Juenemann KP. Experience with botulinum toxin type A in the treatment of neurogenic detrusor overactivity in clinical practice. Ther Adv Urol 2014; 6:34-42. [PMID: 24489607 DOI: 10.1177/1756287213510962] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Control of the lower urinary tract is a complex, multilevel process that involves both the peripheral and central nervous system. Neurogenic lower urinary tract dysfunction (LUTD) is a widespread chronic illness that impairs millions of people worldwide. Neurogenic LUTD has a major impact on quality of life, affecting emotional, social, sexual, occupational and physical aspects of daily life, and in addition to the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system. First-line treatment for neurogenic LUTD includes antimuscarinics and some form of catheterization, preferably intermittent self-catheterization. However, the treatment effect is often unsatisfactory, so that other options have to be considered. Moreover, neurogenic LUTD is a challenge because all available treatment modalities (i.e. conservative, minimally invasive and invasive therapies) may fail. In recent years, botulinum neurotoxin type A (BoNT/A) treatment has been shown to be an effective pharmacological therapy option in patients refractory to antimuscarinic and neurogenic detrusor overactivity (NDO). Several studies have shown that BoNT/A injection significantly reduces detrusor muscle overactivity. Also BoNT/A treatment of NDO has revealed a significant improvement of lower urinary tract function with regard to reduced urinary incontinence, reduced detrusor pressure, increased bladder capacity and improved quality of life in NDO.
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Affiliation(s)
- Stephanie Knuepfer
- Spinal Cord Injury Center & Research, University Zürich, Balgrist University Hospital, Zürich, Forchstrasse 340, 8008 CH, Switzerland
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20
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Goessaert ASOM, Everaert KCMM. Onabotulinum toxin A for the treatment of neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis. Expert Rev Neurother 2014; 12:763-75. [DOI: 10.1586/ern.12.61] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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21
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Chen YC, Kuo HC. The therapeutic effects of repeated detrusor injections between 200 or 300 units of onabotulinumtoxinA in chronic spinal cord injured patients. Neurourol Urodyn 2013; 33:129-34. [PMID: 23494629 DOI: 10.1002/nau.22395] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/13/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the therapeutic effects of repeated detrusor onabotulinumtoxinA injections on treatment outcomes, quality of life (QoL), and glomerular filtration rate (GFR) in chronic spinal cord injured (SCI) patients with neurogenic lower urinary tract dysfunction and urinary incontinence. MATERIALS AND METHODS Patients with SCI who failed antimuscarinic treatment were enrolled. All patients had urodynamic detrusor overactivity (DO) or increased detrusor tonicity without anatomical bladder outlet obstruction or intrinsic sphincter deficiency. They were randomly assigned to receive 200-U or 300-U onabotulinumtoxinA detrusor injections every 6 months. The primary endpoint was 6 months after the second injection. The urodynamic parameters, QoL measures, and 99mTc renal scans were evaluated at baseline and every 3 months and compared between dosages. RESULTS A total of 72 patients were enrolled, including 43 men and 29 women and mean injury duration of 8.7 years. Among them, 38 patients received 200-U and 34 received 300-U onabotulinumtoxinA injections. At the end-point, the urodynamic parameters and incontinence severity improved significantly, without a significant difference between the two groups. QoL also improved in both groups, without differences between groups. Uninhibited DO improved more in 300-U group compared to 200-U group at end-point (P = 0.01). The GFR did not change significantly in either group. The most common complication was urinary tract infection, which occurred in one third of patients. CONCLUSIONS Either 200-U or 300-U repeated detrusor onabotulinumtoxinA injections improved incontinence, urodynamic parameters, and QoL in SCI patients with neurogenic DO. Renal function was maintained in patients receiving both dosage of repeated injections.
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Affiliation(s)
- Yih-Chou Chen
- Department of Urology, Hualien General Hospital, Hualien, Taiwan
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22
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Al-Shaiji TF. Intradetrusor injection of botulinum toxin for the management of refractory overactive bladder syndrome: an update. Surg Innov 2012; 20:351-5. [PMID: 22964263 DOI: 10.1177/1553350612460125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Overactive bladder (OAB) is a common syndrome that has a negative impact on daily activities and quality of life. The first-line treatment to manage this condition includes behavioral modifications, physical treatment, and oral pharmacotherapy with antimuscarinics. Botulinum toxin has emerged as an alternative and second-line treatment option for patients with OAB who are refractory to first-line treatment modalities when injected into the detrusor muscle. Although its application in the management of OAB remains off label, studies have shown its efficacy both subjectively and objectively. It is considered as a minimally invasive and reversible alternative. Adequate dosage of the toxin, number of injection sites, and reinjection rates are yet to be determined. This review attempts to provide an update on the current position of botulinum toxin in managing refractory OAB addressing contemporary data on the mechanism of action, technique, safety, complications, and clinical results.
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Affiliation(s)
- Tariq F Al-Shaiji
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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23
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Do baseline urodynamic parameters affect the treatment outcome after intravesical 100 U onabotulinumtoxinA injection in patients with idiopathic detrusor overactivity? Tzu Chi Med J 2012. [DOI: 10.1016/j.tcmj.2012.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Idiopathic detrusor overactivity (motory urge) negatively affects the live of patients. Conservative treatment is not always effective and has multiple side effects. Sacral neuromodulation is a second line therapy for the treatment of idiopatic detrusor overactivity. Over the last decade, botulinum toxin injections have been increasingly used as alternative although there are only few randomized studies. Goal of this review is to compare efficiacy, safety and cost effectiveness of both methods.
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25
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Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system. J Neurol 2012; 260:701-13. [DOI: 10.1007/s00415-012-6615-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 07/06/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022]
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26
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Sager C, Burek C, Durán V, Corbetta JP, Weller S, Juan B, López JC. Pharmacotherapy in Pediatric Neurogenic Bladder Intravesical Botulinum Toxin Type A. ISRN UROLOGY 2012; 2012:763159. [PMID: 22720170 PMCID: PMC3376763 DOI: 10.5402/2012/763159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 04/05/2012] [Indexed: 11/23/2022]
Abstract
When the neurogenic bladder is refractory to anticholinergics, botulinum toxin type A is used as an alternative. The neurotoxin type A reduces bladder pressure and increases its capacity and wall compliance. Additionally, it contributes to improving urinary continence and quality of life. This novel therapy is ambulatory with a low incidence of adverse effects. Due to its transitory effect, it is necessary to repeat the injections in order to sustain its therapeutic effect. In these review article we talk about Mechanism of Action, Indications, effects, administration and presentations of the Botulinum Neurotoxin Type A in pediatric patients. Also, we make references to controversial issues surrounding its use. A bibliographic search was done selecting articles and revisions from Pubmed. The key words used were botulinum toxin A, neurogenic bladder, and children. The search was limited to patients younger than 18 years of age and reports written in English in the past ten years.
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Affiliation(s)
- Cristian Sager
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Carol Burek
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Victor Durán
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Juan Pablo Corbetta
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Santiago Weller
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Bortagaray Juan
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Juan Carlos López
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
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Abstract
Botulinum toxin has been recently accepted as a novel treatment for lower urinary tract dysfunctions refractory to conventional treatment. Review of the clinical trials in recent years, botulinum toxin type A has been widely used in the urethra or urinary bladder to treat voiding dysfunction due to detrusor sphincter dyssynergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders such as bladder hypersensitivity, overactive bladder, and interstitial cystitis/painful bladder syndrome. Intravesical botulinum toxin type A injection is effective in treatment of urinary incontinence due to detrusor overactivity in men and women, as well as in children. Currently botulinum toxin type A has also been applied to treat lower urinary tract symptoms due to benign prostatic hyperplasia in patients not suitable for surgery. This article reviewed the recent advances of botulinum toxin type A on lower urinary tract dysfunction.
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Affiliation(s)
- Yue-Chen Kuo
- Department of Urology, Yangming Branch of Taipei City Hospital, Taipei, Taiwan
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28
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Standard Pharmacological Treatment and New Therapies for Overactive Bladder. Urologia 2012; 79:6-13. [DOI: 10.5301/ru.2012.9032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2011] [Indexed: 11/20/2022]
Abstract
The prevalence of overactive bladder (OAB) in adult males varies from 10.2% to 17.4%, and in females from 7.7 to 31.3. 16.5% of the adult population presents symptoms consistent with OAB; of these, 37.2% are actually affected. The OAB has a significant effect on the quality of life. Initial treatment includes behavioral therapy, physiotherapy and antimuscarinic drugs. In patients where behavioral modifications fail, treatment is associated with antimuscarinics. The antimuscarinic agents used to treat OAB showed some efficacy, but adverse events too, such as dry mouth, constipation, headache and blurred vision. In selected cases unresponsive to antimuscarinic therapy, it is possible to use second-line treatments represented by sacral neuromodulation and botulinum toxin type A both for idiopathic detrusor overactivity, where it is still an experimental treatment, and for neurogenic cases with 2011 FDA approval. Surgical options represent the last choice for selected cases.
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29
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Treatment satisfaction and goal attainment with onabotulinumtoxinA in patients with incontinence due to idiopathic OAB. Int Urogynecol J 2012; 23:1017-25. [DOI: 10.1007/s00192-011-1655-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 12/24/2011] [Indexed: 10/14/2022]
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Yokoyama T, Chancellor MB, Oguma K, Yamamoto Y, Suzuki T, Kumon H, Nagai A. Botulinum toxin type A for the treatment of lower urinary tract disorders. Int J Urol 2012; 19:202-15. [DOI: 10.1111/j.1442-2042.2011.02946.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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CHEN YC, KUO HC. Difficult Urination Does Not Affect the Successful Outcome after 100U OnabotulinumtoxinA Intravesical Injection in Patients with Idiopathic Detrusor Overactivity. Low Urin Tract Symptoms 2011; 4:29-34. [DOI: 10.1111/j.1757-5672.2011.00102.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Biomaterials integrate with the anatomy and provide support to the weakened area. They are generally synthetic, but natural substances are also used. These substances are being increasingly used in stress urinary incontinence. This article discusses the various biomaterials, minimally invasive techniques, and recent advances for the treatment of female stress urinary incontinence. In addition, their complications and subsequent management are explored.
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Affiliation(s)
- Philippa Sangster
- Department of Urology, Kingston Hospital, Galsworthy Rd, London KT2 UK
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Altaweel W, Mokhtar A, Rabah DM. Prospective randomized trial of 100u vs 200u botox in the treatment of idiopathic overactive bladder. Urol Ann 2011; 3:66-70. [PMID: 21747594 PMCID: PMC3130480 DOI: 10.4103/0974-7796.82170] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 12/19/2010] [Indexed: 12/04/2022] Open
Abstract
Aim: To evaluate the clinical outcomes of two different doses of BTX-A in patients with refractory idiopathic overactive bladder. Patients and Methods: Thirty nine patients with refractory idiopathic overactive bladder from 1/1/2008 till 30/3/2009 were evaluated in a tertiary care hospital. Patients were evaluated using urodynamic studies, voiding diary, UDI-6 and IIQ-7 questionnaires prior to being prospectively randomized (alternate randomization) to the BTX-A applications and three months after treatment. Voiding diary and residual volume were followed two weeks later. All patients received intradetrusorial injections of BTX-A (Botox, Allergan, Irvine, CA) of 100u or 200u under cystoscopic control on an outpatient basis. The primary endpoint was assessed for the improvement of urodynamic parameters and adverse events at three months after the initial treatment. Secondary end points included urinary frequency, urgency and UUI episodes as assessed by voiding diary and QoL. Results: Eleven patients were enrolled to each arm of the study. There were no significant differences in demographic characteristics between the two groups. Urodynamic assessment at the end of the third month showed significant improvement in urodynamic variables in both groups. There was no statistically significant difference in urodynamic parameters and in the voiding diary between the two groups. QOL was significantly improved in both groups with no statistically significant difference between the different doses. Only three patients developed acute urinary retention. Conclusion: BTX-A at 100u and 200u appears to improve symptoms, urodynamic parameters and QoL with no statistical significance between the two groups.
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Affiliation(s)
- Waleed Altaweel
- King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh, Saudi Arabia
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Kuo HC. Reduction of urgency severity is associated with long-term therapeutic effect after intravesical onabotulinumtoxina injection for idiopathic detrusor overactivity. Neurourol Urodyn 2011; 30:1497-502. [DOI: 10.1002/nau.21132] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 03/15/2011] [Indexed: 11/10/2022]
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Herschorn S, Gajewski J, Ethans K, Corcos J, Carlson K, Bailly G, Bard R, Valiquette L, Baverstock R, Carr L, Radomski S. Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence: a randomized, double-blind trial. J Urol 2011; 185:2229-35. [PMID: 21497851 DOI: 10.1016/j.juro.2011.02.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Indexed: 01/09/2023]
Abstract
PURPOSE We determined the efficacy of onabotulinumtoxinA for neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis. MATERIALS AND METHODS In a prospective, double-blind, multicenter study 57 patients 18 to 75 years old with neurogenic detrusor overactivity secondary to spinal cord injury or multiple sclerosis and urinary incontinence (defined as 1 or more occurrences daily) despite current antimuscarinic treatment were randomized to onabotulinumtoxinA 300 U (28) or placebo (29) via cystoscopic injection at 30 intradetrusor sites, sparing the trigone. Patients were offered open label onabotulinumtoxinA 300 U at week 36 and followed a further 6 months while 24 each in the treatment and placebo groups received open label therapy. The primary efficacy parameter was daily urinary incontinence frequency on 3-day voiding diary at week 6. Secondary parameters were changes in the International Consultation on Incontinence Questionnaire and the urinary incontinence quality of life scale at week 6. Diary and quality of life evaluations were also done after open label treatment. RESULTS The mean daily frequency of urinary incontinence episodes was significantly lower for onabotulinumtoxinA than for placebo at week 6 (1.31 vs 4.76, p <0.0001), and for weeks 24 and 36. Improved urodynamic and quality of life parameters for treatment vs placebo were evident at week 6 and persisted to weeks 24 to 36. The most common adverse event in each group was urinary tract infection. CONCLUSIONS In adults with antimuscarinic refractory neurogenic detrusor overactivity and multiple sclerosis onabotulinumtoxinA is well tolerated and provides clinically beneficial improvement for up to 9 months.
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Affiliation(s)
- Sender Herschorn
- Division of Urology, University of Toronto, Sunnybrook Health Sciences Centre, Room A309, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada.
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Rovner E, Kennelly M, Schulte-Baukloh H, Zhou J, Haag-Molkenteller C, Dasgupta P. Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder. Neurourol Urodyn 2011; 30:556-62. [PMID: 21351127 DOI: 10.1002/nau.21021] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 09/21/2010] [Indexed: 12/31/2022]
Abstract
AIMS We assessed the effects of onabotulinumtoxinA (BOTOX®) on clinical and urodynamic variables in patients with idiopathic overactive bladder (OAB) and urinary urgency incontinence (UUI) with or without detrusor overactivity (DO), inadequately managed with anticholinergics. METHODS Three hundred thirteen patients with OAB were randomized to double-blind intradetrusor injection with placebo (n = 44) or 1 of 5 onabotulinumtoxinA doses (50-300 U; n = 269). Primary efficacy variable was change from baseline in UUI episodes/week at week 12. Urodynamic assessments at baseline and weeks 12 and 36 included maximum cystometric capacity (MCC) and volume at first involuntary detrusor contraction (IDC). RESULTS 76.0% of patients had baseline DO. Changes from baseline in MCC and volume at first IDC with onabotulinumtoxinA ≥100 U were superior to placebo at week 12, generally decreasing by week 36. Significant dose-dependent increases in MCC were observed for all onabotulinumtoxinA doses at week 12, and for 150, 200, and 300 U at week 36. Data suggested a dose-response relationship. At week 12 on diary, 15.9% of placebo and 29.8-57.1% of onabotulinumtoxinA 50-300 U recipients, respectively, did not demonstrate UUI. OnabotulinumtoxinA doses >150 U were more commonly associated with post-void residual urine volumes >200 ml. CONCLUSIONS Improvements in urodynamic parameters and clinical outcomes generally trended together following onabotulinumtoxinA treatment. This therapy improved key urodynamic parameters in patients with idiopathic OAB and UUI, with no differences in outcomes between those with and those without baseline DO. Therefore, successful idiopathic OAB treatment with onabotulinumtoxinA does not appear to be related to pretreatment finding of DO.
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Affiliation(s)
- Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina 29403, USA.
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Apostolidis A. Pharmacotherapy for overactive bladder: minimally invasive treatment – botulinum toxins. Expert Opin Pharmacother 2011; 12:1029-39. [DOI: 10.1517/14656566.2011.554398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Smaldone MC, Ristau BT, Leng WW. Botulinum Toxin Therapy for Neurogenic Detrusor Overactivity. Urol Clin North Am 2010; 37:567-80. [DOI: 10.1016/j.ucl.2010.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dmochowski R, Chapple C, Nitti VW, Chancellor M, Everaert K, Thompson C, Daniell G, Zhou J, Haag-Molkenteller C. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol 2010; 184:2416-22. [PMID: 20952013 DOI: 10.1016/j.juro.2010.08.021] [Citation(s) in RCA: 267] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Indexed: 02/04/2023]
Abstract
PURPOSE Treatment options for patients with overactive bladder refractory to anticholinergics are limited. We assessed the dose response across a range of doses of onabotulinumtoxinA (BOTOX®) in patients with idiopathic overactive bladder and urinary urgency incontinence whose symptoms were not adequately managed with anticholinergics. MATERIALS AND METHODS In a phase 2, multicenter, randomized, double-blind study, 313 patients with idiopathic overactive bladder and urinary urgency incontinence experiencing 8 or more urinary urgency incontinence episodes a week and 8 or more micturitions daily at baseline received 50, 100, 150, 200 or 300 U intradetrusor onabotulinumtoxinA, or placebo. Symptoms were recorded using a 7-day bladder diary. The primary efficacy variable was weekly urinary urgency incontinence episodes and the primary end point was week 12. RESULTS Demographics and baseline characteristics were balanced across the treatment groups. Durable efficacy was observed for all onabotulinumtoxinA dose groups of 100 U or greater for primary and secondary efficacy measures, including the proportion of incontinence-free patients. When the dose response curves were analyzed, doses greater than 150 U contributed minimal additional or clinically relevant improvement in symptoms. This finding was also reflected in health related quality of life assessments. Dose dependent changes in post-void residual urine volume were observed and the use of clean intermittent catheterization was also dose dependent. The only adverse events significantly greater with onabotulinumtoxinA than with placebo were urinary tract infection and urinary retention. CONCLUSIONS OnabotulinumtoxinA at doses of 100 U or greater demonstrated durable efficacy in the management of idiopathic overactive bladder and urinary urgency incontinence. A dose of 100 U may be the dose that appropriately balances the symptom benefits with the post-void residual urine volume related safety profile.
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Affiliation(s)
- Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennessee 37232, USA.
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Adverse events of intravesical botulinum toxin a injections for idiopathic detrusor overactivity: risk factors and influence on treatment outcome. Eur Urol 2010; 58:919-26. [PMID: 20864251 DOI: 10.1016/j.eururo.2010.09.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/06/2010] [Indexed: 01/21/2023]
Abstract
BACKGROUND Intravesical injection of botulinum toxin type A (BoNTA) provides effective treatment for detrusor overactivity and overactive bladder (OAB). However, the high rates of treatment-related adverse events (AEs) prevent its more widespread use. OBJECTIVE To investigate the risk factors of increasing AEs after BoNTA injection for idiopathic detrusor overactivity (IDO). DESIGN, SETTING, AND PARTICIPANTS This study included a total of 217 patients receiving their first intravesical BoNTA injection for refractory IDO in a tertiary university hospital from 2004 to 2009. MEASUREMENTS AE incidence was analyzed according to gender, age, comorbidities, prostate condition in men, OAB subtype, BoNTA dose, injection site, and baseline urodynamic parameters. Successful outcome was determined based on patient perception of improvement of bladder condition at 3 mo. RESULTS AND LIMITATIONS Successful outcomes were reported by 144 (66.3%) patients. By multivariable analysis, male gender (p=0.013) and baseline postvoid residual (PVR) ≥100ml (p=0.003) were independent predictors of acute urinary retention (AUR). Baseline PVR ≥100ml (p=0.007) and receiving >100 U BoNTA (p=0.029) were predictors of straining to void. The incidence of large PVR after treatment was associated with comorbidity (p=0.011). Urinary tract infection occurred more frequently in women (p=0.003) and in men with retaining prostate (p=0.008). No AUR developed after bladder base/trigonal injection. Nevertheless, the occurrence of AUR or large PVR did not affect therapeutic outcome. This study is limited by nonconsecutive enrollment of patients. CONCLUSIONS Male gender, baseline PVR ≥100ml, comorbidity, and BoNTA dose >100 U are risk factors for increasing incidence of AEs after intravesical BoNTA injection for IDO.
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Boongird S, Shah N, Nolin TD, Unruh ML. Nocturia and aging: diagnosis and treatment. Adv Chronic Kidney Dis 2010; 17:e27-40. [PMID: 20610352 DOI: 10.1053/j.ackd.2010.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 04/23/2010] [Accepted: 04/30/2010] [Indexed: 12/27/2022]
Abstract
Nocturia is a frequently encountered problem in clinical practice and a reason for nephrology consultation. Many studies have clearly shown the negative effect of nocturia on several aspects of health-related quality of life and morbidity. Age-associated physiological, structural, hormonal, and histological changes play an important role in the increasing incidence of nocturia in elderly individuals. Besides urologic conditions, nocturia may also be the initial presenting symptom in chronic kidney disease, as well as other systemic diseases. Therefore, it is essential to understand the complex pathophysiology among these factors to establish a precise diagnosis and appropriate management strategies. This review will provide an overview of the effect of aging on the kidneys and urinary system, the pathophysiology, clinical assessment, and treatment strategies of nocturia, and its effect on health-related quality of life.
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Oeconomou A, Apostolidis A. Current Status of Botulinum Toxin for Neurogenic Bladder Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Intravesical Botulinum Toxin Injection for Overactive Bladder—What We Can Learn From Previous Clinical Trials. Tzu Chi Med J 2009. [DOI: 10.1016/s1016-3190(09)60056-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Campbell JD, Gries KS, Watanabe JH, Ravelo A, Dmochowski RR, Sullivan SD. Treatment success for overactive bladder with urinary urge incontinence refractory to oral antimuscarinics: a review of published evidence. BMC Urol 2009; 9:18. [PMID: 19930578 PMCID: PMC2788579 DOI: 10.1186/1471-2490-9-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 11/20/2009] [Indexed: 11/10/2022] Open
Abstract
Background Treatment options for overactive bladder (OAB) with urinary urge incontinence (UUI) refractory to oral antimuscarinics include: botulinum toxin type A (BoNTA), sacral neuromodulation (SNM), and augmentation cystoplasty (AC). A standard treatment success metric that can be used in both clinical and economic evaluations of the above interventions has not emerged. Our objective was to conduct a literature review and synthesis of published measures of treatment success for OAB with UUI interventions and to identify a treatment success outcome. Methods We performed a literature review of primary studies that used a definition of treatment success in the OAB with UUI population receiving BoNTA, SNM, or AC. The recommended success outcome was compared to generic and disease-specific health-related quality-of-life (HRQoL) measures using data from a BoNTA treatment study of neurogenic incontinent patients. Results Across all interventions, success outcomes included: complete continence (n = 23, 44%), ≥ 50% improvement in incontinence episodes (n = 16, 31%), and subjective improvement (n = 13, 25%). We recommend the OAB with UUI treatment success outcome of ≥ 50% improvement in incontinence episodes from baseline. Using data from a neurogenic BoNTA treatment study, the average change in the Incontinence Quality of Life questionnaire was 8.8 (95% CI: -4.7, 22.3) higher for those that succeeded (N = 25) versus those that failed (N = 26). The average change in the SF-6D preference score was 0.07 (95% CI: 0.02, 0.12) higher for those that succeeded versus those that failed. Conclusion A treatment success definition that encompasses the many components of underlying OAB with UUI symptoms is currently not practical as a consequence of difficulties in measuring urgency. The treatment success outcome of ≥ 50% improvement in incontinence episodes was associated with a clinically meaningful improvement in disease-specific HRQoL for those with neurogenic OAB with UUI. The recommended success definition is less restrictive than a measure such as complete continence but includes patients who are satisfied with treatment and experience meaningful improvement in symptoms. A standardized measure of treatment success will be useful in clinical and health economic applications.
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Ksibi I, Godard AL, Azouvi P, Denys P, Dziri C. Botulinum toxin and refractory non-neurogenic overactive detrusor. Ann Phys Rehabil Med 2009; 52:668-83. [DOI: 10.1016/j.rehab.2009.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 07/02/2009] [Indexed: 11/24/2022]
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Amend B, Castro-Diaz D, Chartier-Kastler E, De Ridder D, Everaert K, Spinelli M, van Kereebroeck P, Sievert KD. Second-line-Therapie der idiopathisch überaktiven Blase. Urologe A 2009; 49:245-52. [DOI: 10.1007/s00120-009-2139-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brin MF. Development of future indications for BOTOX®. Toxicon 2009; 54:668-74. [DOI: 10.1016/j.toxicon.2009.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 01/14/2009] [Indexed: 11/30/2022]
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