Recommandations pour le traitement de l’incontinence urinaire féminine par hyperactivité vésicale idiopathique réfractaire par la toxine botulique A

Systematic review of guidelines for urinary incontinence in women

INTRODUCTION AND OBJECTIVE

Urinary incontinence in women is the subject of multiple recommendations all over the world. The aim of our study was to compare methodologies and search for inconsistencies in texts and grades in these guidelines.

METHODS

Seventeen recommendations from different medical societies in English, French and German were included. Their methodologies were analyzed, including writing methods, cyclicity, level of evidence (LE) and grades. The recommendations were synthesized and inconsistencies in texts and grades were studied. The quality of recommendations was evaluated with the Appraisal of Guidelines for Research and Evaluation (AGREE II) scale.

RESULTS

Methods, rigour and cyclicity varied depending on societies. LE and grades are broadly consensual for higher LE and grades and less so for lower LE and grades. The Collège National des Gynécologues et Obstétriciens Français, the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, the European Association of Urology, the International Consultation on Urological Diseases and the National Institute for Health and Care Excellence have an AGREE score ≥ 80 % (third quartile). Grading and textual inconsistencies are explained by the order of studies or the absence of high LE.

CONCLUSION

With the present study we closely explored comparatively the methods and semantics of recommendations for urinary incontinence in women.

Botulinum toxin injections in the management of non-neurogenic overactive bladders in children

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.

[Botulinum toxin A intradetrusor injections in consultation: single center experience during 2 years]

OBJECTIVES

In departments of urology, intradetrusor botulinum toxin injections are routinely performed in ambulatory outpatient clinic. The aim of the study was to assess the satisfaction level of patients treated with this technique.

PATIENTS AND METHODS

A satisfaction questionnaire was carried out by telephone for all patients treated in ambulatory outpatient clinic from 2009 to 2010.

RESULTS

Twenty-six patients were treated in consultation during the studied period for a total of 46 sessions of injections. The average age was 48.81 (±16.78) years. An injection programme containing 20 or 30 points was performed after a local anesthetic. Twenty patients answered the questionnaire. As regards the organization of the injections, 12 patients (60%) declared to have been satisfied and seven very satisfied (35%). Eight patients (40%) were very satisfied with the management of the pain and six (30%) satisfied versus only one (5%) not satisfied at all. For the time spent in the hospital during the injections, 10 (50%) were satisfied and seven (35%) very satisfied. Only 4 patients (20%) would have preferred to be hospitalized in an outpatient facility. In cases of new injections, 18 (90%) patients would have preferred an identical coverage. Finally, 17 (85%) would recommend this procedure to one of their close relations.

CONCLUSION

Our results showed that the majority of patients were completely satisfied with the injection programme. However, as patients are not currently covered by the national health system for these injections, this might hinder the development of this procedure.