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Truong XQ, Bakali Issaui Z, Gaillet S, Boissier R, Gondran-Tellier B, Delporte V, Lechevallier E, Karsenty G, Michel F. [Bladder augmentation in the era of botulinum toxin: Indications and results]. Prog Urol 2023; 33:547-554. [PMID: 37666743 DOI: 10.1016/j.purol.2023.07.010] [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] [Received: 04/28/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 09/06/2023]
Abstract
AIM To determine the surgical indication and results of bladder augmentation (BA) during the last decade in a neurourology center in the era of intradetrusor botulinum toxin injection. MATERIAL We conducted a retrospective study that included patients with BA between January 1, 2012 and December 31, 2022 in our centre. We collected pre-operative demographic, clinical, and urodynamic data, BA indication, and associated procedures. We analyzed early and late complications as well as continence and postoperative voiding mode in patients with first BA in a neurological pathology context. RESULTS We performed 77 BA over the study period. The main indication was neurogenic overactive bladder, which was secondarily resistant to botulinum toxin. The main associated procedure was continent cutaneous diversion (n=31, 57.4%). Among patients who had a first BA for neurogenic bladder, 34 patients had early complications (50%) including 12 patients with≥Clavien 3 complications (17.6%). After a median follow-up of 33 [14; 55] months, 23 patients had late complications (33.8%) and 59 patients had complete continence (86.8%). CONCLUSION In the era of botulinum toxin, the main indication of BA is the secondary failure of botulinum toxin for overactive neurogenic bladder. The BA provided continence in 86.8% of patients. It remains however an intervention with a significant rate of severe complications whose indication must be discussed by a multidisciplinary team. LEVEL OF EVIDENCE Weak.
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Affiliation(s)
- X Q Truong
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - Z Bakali Issaui
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - S Gaillet
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - R Boissier
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - B Gondran-Tellier
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - V Delporte
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - E Lechevallier
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - G Karsenty
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
| | - F Michel
- CCA d'urologie, service d'urologie et de transplantation rénale, hôpital de la Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France.
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Denys P, Castaño Botero JC, Vita Nunes RL, Wachs B, Mendes Gomes C, Krivoborodov G, Tu LM, Del-Popolo G, Thompson C, Vilain C, Volteau M, Kennelly M. AbobotulinumtoxinA is effective in patients with urinary incontinence due to neurogenic detrusor overactivity regardless of spinal cord injury or multiple sclerosis etiology: Pooled analysis of two phase III randomized studies (CONTENT1 and CONTENT2). Neurourol Urodyn 2023; 42:153-167. [PMID: 36321799 PMCID: PMC10092111 DOI: 10.1002/nau.25062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurogenic detrusor overactivity incontinence (NDOI) is often inadequately managed with oral therapy. OBJECTIVE To assess efficacy and safety of abobotulinumtoxinA (aboBoNT-A; Dysport®; Ipsen Ltd.) according to etiology of NDOI. DESIGN, SETTING, AND PARTICIPANTS Two phase III, randomized, double-blind studies (CONTENT1 [NCT02660138] conducted in Asia, Europe and North America; CONTENT2 [NCT02660359] conducted in the Americas, Asia, Europe and Oceania) both included patients with spinal cord injury (SCI) or multiple sclerosis (MS), with inadequately managed NDOI, regularly performing clean intermittent catheterization (CIC). INTERVENTION Patients in CONTENT1 and CONTENT2 received aboBoNT-A injections 600 U (n = 162)/800 U (n = 161), or placebo (n = 162) into the detrusor muscle. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary endpoint: mean change from baseline in number of NDOI episodes/week at Week 6. Secondary endpoints: proportion of patients with no NDOI episodes; incontinence-related quality of life (I-QoL); urodynamic parameters; and time-to-retreatment. Safety was also assessed. Statistical analyses were conducted for pooled populations by etiology (aboBoNT-A doses vs. placebo). RESULTS AND LIMITATIONS Of 485 randomized patients, 341 (70%) and 144 (30%) had SCI and MS etiologies, respectively. A significant reduction was observed in mean NDOI episodes/week at Week 6 with both aboBoNT-A doses versus placebo in the SCI (all p < 0.001) and MS (all p < 0.01) groups, as well as significant improvements in I-QoL and urodynamic parameters. Median time-to-retreatment was longer in patients with MS (48-62 weeks across doses) than those with SCI (39-44 weeks). Safety data were similar between etiologies. Urinary tract infection was the most frequent adverse event; similar numbers were reported across treatment groups. CONCLUSIONS AboBoNT-A was well tolerated and significantly improved continence and bladder function, and QoL, in patients with SCI or MS with NDOI performing regular CIC. PATIENT SUMMARY AboBoNT-A injections improved QoL, symptoms, and bladder function in patients with SCI or MS with bladder muscle overactivity that causes incontinence.
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Affiliation(s)
- Pierre Denys
- Department of Neuro-Urology and Andrology, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris, Garches, France
| | | | | | - Barton Wachs
- Chief Urology Section, Atlantic Urology Medical Group, Long Beach, California, USA
| | | | - Grigory Krivoborodov
- Department of Urology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Le Mai Tu
- Urology Division, Department of Surgery, Faculty of Medicine, Sherbrooke University Hospital Center, Sherbrooke, Quebec, Canada
| | - Giulio Del-Popolo
- Department of Neurourology, Careggi University Hospital, Florence, Italy
| | | | - Claire Vilain
- R&D, Clinical Development Operations Department, Biostatistics and Sataistical Programing Group, Ipsen Innovation, Les Ulis, France
| | - Magali Volteau
- R&D, Clinical Development Operations Department, Biostatistics and Sataistical Programing Group, Ipsen Innovation, Les Ulis, France
| | - Michael Kennelly
- Department of Urology, Atrium Health, Carolinas Medical Center, Charlotte, North Carolina, USA
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3
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Efficacy and Safety of AbobotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity Incontinence Performing Regular Clean Intermittent Catheterization: Pooled Results from Two Phase 3 Randomized Studies (CONTENT1 and CONTENT2). Eur Urol 2022; 82:223-232. [DOI: 10.1016/j.eururo.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022]
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Barba M, Lazar T, Cola A, Marino G, Manodoro S, Frigerio M. Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder. Int J Womens Health 2022; 14:1-7. [PMID: 35018123 PMCID: PMC8742680 DOI: 10.2147/ijwh.s345454] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Intradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB. PATIENTS AND METHODS This retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients' outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident. RESULTS Twenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2-2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability. CONCLUSION Intradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.
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Affiliation(s)
- Marta Barba
- University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Tetyana Lazar
- University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Alice Cola
- University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Marino
- University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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Systemic muscular weakness after botulinum toxin A administration: a review of the literature. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6
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Vaidyanathan S, Foster T, Soni BM. Generalised muscle weakness after bladder wall injection of Abobotulinum Toxin A: experience of a woman with tetraplegia who required increased caregiver support: importance of doctor-patient communication: duty of candour for spinal cord physician and responsibilities of a patient. Spinal Cord Ser Cases 2018; 4:103. [PMID: 30455987 PMCID: PMC6234204 DOI: 10.1038/s41394-018-0128-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Generalised muscle weakness can occur after bladder wall injection of Abobotulinum toxin and the patient may require additional caregiver support. CASE PRESENTATION A woman with C-8 AIS A tetraplegia received bladder wall injection of Abobotulinum toxin A 1000 units for detrusor over-activity. After 2.5 weeks, she developed weakness of arms; could not lift herself for pressure relief; could not transfer using sliding board; she regained the original muscle strength in 6 weeks. After 13 months, Abobotulinum toxin A 1000 units were injected into detrusor. Ten days after the second Abobotulinum toxin A injection, she developed generalised muscle weakness. She had not regained full function in her arms and hands 8 months later.Prior to bladder wall injection of Abobotulinum toxin A, this patient was not aware that she could develop muscle weakness albeit very rarely. Therefore, the patient made no association of the muscle weakness, which occurred after the first injection, to Abobotulinum toxin A. For this reason, she did not inform the clinicians that she developed weakness of upper limbs following Abobotulinum toxin A injection. As she was not informed of this side effect before the second bladder wall injection of Abobotulinum toxin A, she consented to undergo the repeat procedure and developed generalised muscle weakness. DISCUSSION Patients should inform doctors the adverse effects of medical therapy so that future treatment is amended to ensure patient safety. Professional duty of candour states that doctors should discuss risks which occur often, those that are serious even if very unlikely, and those that are important to the patient.
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Affiliation(s)
- Subramanian Vaidyanathan
- 0000 0004 0417 1480grid.415968.7Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN United Kingdom
| | | | - Bakul M. Soni
- 0000 0004 0417 1480grid.415968.7Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN United Kingdom
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Peyronnet B, Gamé X, Vurture G, Nitti VW, Brucker BM. Botulinum Toxin Use in Neurourology. Rev Urol 2018; 20:84-93. [PMID: 30288145 DOI: 10.3903/riu0792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The use of botulinum toxin A (BTX-A) has revolutionized the treatment of neurogenic lower urinary tract dysfunction (NLUTD) over the past three decades. Initially, it was used as a sphincteric injection for detrusor sphincter dyssynergia but now is used mostly as intradetrusor injection to treat neurogenic detrusor overactivity (NDO). Its use is supported by high-level-of-evidence studies and it has become the gold-standard treatment for patients with NDO refractory to anticholinergics. Several novelties have emerged in the use of BTX-A in neurourology over the past few years. Although onabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA) remains the only BTX-A for which use is supported by large, multicenter, randomized, controlled trials (RCT), and is therefore the only one to be licensed in the United States and Europe, a second BTX-A, abobotulinumtoxinA (Dysport®, Ipsen Biopharmaceuticals, Basking Ridge, NJ), is also supported by high-level-of-evidence studies. Other innovations in the use of BTX-A in neurourology during the past few years include the BTX switch (from abobotulinumtoxinA to onabotulinumtoxinA or the opposite) as a rescue option for primary or secondary failures of intradetrusor BTX-A injection and refinements in intradetrusor injection techniques (number of injection sites, injection into the trigone). There is also a growing interest in long-term failure of BTX-A for NDO and their management, and a possible new indication for urethral sphincter injections.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes Rennes, France.,Department of Urology, New York University New York, NY
| | - Xavier Gamé
- Department of Urology, University of Toulouse Toulouse, France
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8
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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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9
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Bottet F, Peyronnet B, Boissier R, Reiss B, Previnaire JG, Manunta A, Kerdraon J, Ruffion A, Lenormand L, Perrouin Verbe B, Gaillet S, Gamé X, Karsenty G. Switch to Abobotulinum toxin A may be useful in the treatment of neurogenic detrusor overactivity when intradetrusor injections of Onabotulinum toxin A failed. Neurourol Urodyn 2017; 37:291-297. [PMID: 28431196 DOI: 10.1002/nau.23291] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/27/2017] [Indexed: 11/08/2022]
Abstract
AIMS To assess the outcomes of switching to a different brand of botulinum toxin A (BTA, from Botox® to Dysport®) in case of failure of intradetrusor injections (IDI) of Botox® in the treatment of neurogenic detrusor overactivity (NDO). METHODS The charts of all patients who underwent a switch to IDI of Dysport® after failure of an IDI of Botox® at six departments of neurourology were retrospectively reviewed. The main outcomes of interest were the bladder diary data and four urodynamic parameters: maximum cystometric capacity (MCC), maximum detrusor pressure (PDET max), and volume at first uninhibited detrusor contraction (UDC). RESULTS Fifty-seven patients were included. After the first injection of Dysport®, no adverse events were reported. A significant decrease in number of urinary incontinence episodes per day was observed in 52.63% of patients (P < 0.001) and all patients experienced a reduction in PDET Max (-8.1 cmH20 on average; P = 0.003). MCC significantly increased by a mean of 41.2 (P = 0.02). The proportion of patients with no UDC increased significantly at week 6 after ATA injections (from 15.79% to 43.9%; P = 0.0002). Hence, 32 patients draw clinical and/or urodynamic benefits from the botulinum toxin switch from (56.14%). After a median follow up of 21 months, 87% of responders to BTA switch were still treated successfully with BTA. CONCLUSION Most patients refractory to Botox® (56.14%) draw benefits from the switch to Dysport®.
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Affiliation(s)
- Florie Bottet
- Department of Urology, Tenon Hospital, Paris, France
| | - Benoit Peyronnet
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Romain Boissier
- Department of Urology, University Hospital of Marseille, Marseille, France
| | - Bénédicte Reiss
- Department of Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France
| | - Jean G Previnaire
- Department of Physical Medicine and Rehabilitation, Jacques-Calvé Center, Berck, France
| | - Andrea Manunta
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Jacques Kerdraon
- Department of Physical Medicine and Rehabilitation, Kerpape Hospital, Ploemeur, France
| | - Alain Ruffion
- Department of Urology, University Hospital of Lyon, Lyon, France
| | - Loïc Lenormand
- Department of Urology, University Hospital of Nantes, Nantes, France
| | - Brigitte Perrouin Verbe
- Department of Physical Medicine and Rehabilitation, University Hospital of Nantes, Nantes, France
| | - Sarah Gaillet
- Department of Urology, University Hospital of Marseille, Marseille, France
| | - Xavier Gamé
- Department of Urology, University Hospital of Toulouse, Toulouse, France
| | - Gilles Karsenty
- Department of Urology, University Hospital of Marseille, Marseille, France
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10
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Peyronnet B, Castel-Lacanal E, Roumiguie M, Even L, Marque P, Soulié M, Rischmann P, Game X. Intradetrusor injections of onabotulinum toxin A (Botox®) 300 U or 200 U versus abobotulinum toxin A (Dysport®) 750 U in the management of neurogenic detrusor overactivity: A case control study. Neurourol Urodyn 2016; 36:734-739. [DOI: 10.1002/nau.23009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/13/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Benoit Peyronnet
- Service d'Urologie; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | | | - Mathieu Roumiguie
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Lucie Even
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Philippe Marque
- Service de Médecine Physique et Réadaptation; CHU Rangueil; Toulouse France
| | - Michel Soulié
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Pascal Rischmann
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Xavier Game
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
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11
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Peyronnet B, Roumiguié M, Castel-Lacanal E, Guillotreau J, Marque P, Rischmann P, Gamé X. Efficacy and safety of the first and repeated intradetrusor injections of abobotulinum toxin A 750 U for treating neurological detrusor overactivity. World J Urol 2015; 34:755-61. [PMID: 26282099 DOI: 10.1007/s00345-015-1666-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess clinical and urodynamic efficacy of the first and repeated intradetrusor injections of abobotulinum toxin A (Dysport(®), Ipsen(®), France) in patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergic treatment. METHODS A single-center retrospective study was conducted in 81 consecutive patients who had never received any botulinum toxin intradetrusor injections. They were treated with at least one 750 U intradetrusor injection of abobotulinum toxin A. All patients performed clean intermittent self-catheterization (CIC) before injections. Success was defined as a combination of no incontinence episode, a number of catheterization <8 reported in a 3-day bladder diary and the lack of detrusor overactivity. RESULTS Six weeks after the first injection, the success rate was 64.2 %. The proportion of continent patients was 80.2 %, the mean number of CIC per 24 h reduced (-3.55, p < 0.0001) and the mean catheterization volume increased (+237.3 ml, p < 0.0001). Regarding urodynamics, mean maximum cystometric capacity and mean volume at the first uninhibited contraction increased (+132.7 ml, p < 0.0001 and +180 ml, p < 0.0001, respectively) and mean maximum bladder pressure decreased significantly (-21.5 cm H2O, p < 0.0001). Mean reinjection number was 3.9 and mean interval between reinjection was 8.8 ± 3 months. The clinical efficacy rate after each reinjection (up to fourteen) was at least 86.7 %. Out of 55 patients who underwent repeated injections, secondary resistance was noted in 2 (3.6 %). CONCLUSION The results of the present study are in favor of a long-term safety and efficacy of abobotulinum toxin A 750 U for NDO.
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Affiliation(s)
- Benoit Peyronnet
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France. .,Service d'urologie, CHU Rennes, Rennes, France.
| | - Mathieu Roumiguié
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France
| | | | - Julien Guillotreau
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France.,Service d'urologie, Clinique Pasteur, Toulouse, France
| | - Philippe Marque
- Service de Médecine Physique et Réadaptation, CHU Rangueil, Toulouse, France
| | - Pascal Rischmann
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France
| | - Xavier Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France
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12
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Efficacy and duration of response to botulinum neurotoxin A (onabotulinumA) as a treatment for detrusor overactivity in women. Int Urogynecol J 2015; 26:1605-12. [PMID: 26164156 DOI: 10.1007/s00192-015-2751-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Overactive bladder syndrome with urinary incontinence has a number of treatment options. The National Institute for Health and Care Excellence (NICE) in the UK, the American Urological Association (AUA) and the European Association of Urology (EAU) recommend intradetrusor botulinum neurotoxin A (onabotulinumA) injections in women with proven detrusor overactivity (DO) in whom conservative therapies have failed to improve symptoms. However, the effects of individual onabotulinumA treatments are of short duration and patients usually require further treatments. There is little evidence to inform long-term management strategies using onabotulinumA for DO. METHODS A retrospective review of patients receiving intradetrusor onabotulinumA injections for DO over a 7-year period was conducted. The primary outcome measures included patient's subjective reports of symptom change following injections (efficacy) and the duration of symptomatic relief following each treatment. RESULTS The analysis included 136 patients. The mean time between patients receiving intradetrusor onabotulinumA and being added to the surgical waiting list for re-treatment varied between 8.5 and 10.4 months for the first five cycles of treatment with the longest time between the third and fourth cycles. This decreased to 5.5 and 5.25 (ANOVA p = 0.015) between the fifth and sixth cycles and between the sixth and seventh cycles of treatment, respectively. Only 19.9% of patients continued treatment beyond this, with four patients receiving a seventh treatment. CONCLUSIONS Our results suggest that in patients who respond to onabotulinumA treatment, the duration of response declines after the fifth treatment, suggesting a possible tolerance effect and a subsequent decline in efficacy.
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Delayed contrast-enhanced MRI to localize Botox after cystoscopic intravesical injection. Int Urol Nephrol 2015; 47:893-8. [DOI: 10.1007/s11255-015-0976-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/05/2015] [Indexed: 10/23/2022]
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Peyronnet B, Roumiguié M, Castel-Lacanal E, Guillotreau J, Malavaud B, Marque P, Rischmann P, Gamé X. Preliminary results of botulinum toxin A switch after first detrusor injection failure as a treatment of neurogenic detrusor overactivity. Neurourol Urodyn 2014; 35:267-70. [DOI: 10.1002/nau.22712] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/27/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Benoit Peyronnet
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Mathieu Roumiguié
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | | | - Julien Guillotreau
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Bernard Malavaud
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Philippe Marque
- Service de Médecine Physique et Réadaptation; CHU Rangueil; Toulouse France
| | - Pascal Rischmann
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Xavier Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
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Yonnet GJ, Fjeldstad AS, Carlson NG, Rose JW. Advances in the management of neurogenic detrusor overactivity in multiple sclerosis. Int J MS Care 2014; 15:66-72. [PMID: 24453765 DOI: 10.7224/1537-2073.2012-031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bladder dysfunction in multiple sclerosis (MS) can be socially disabling, have negative psychological and economic consequences, and impair patients' quality of life. Knowledge of the functional anatomy and physiology of the urinary tract is essential to understand the symptoms associated with central nervous system lesions and the pharmacotherapies used to treat them. Treatments for neurogenic detrusor overactivity (NDO) have consisted mainly of administration of anticholinergic drugs, which have been shown to provide suboptimal clinical benefits and be poorly tolerated. The US Food and Drug Administration (FDA) approval of intravesicular botulinum toxin therapy provides a second-line option for MS patients with NDO not responsive to anticholinergic drugs. We performed a review of key literature pertaining to the intravesicular application of botulinum toxin. In the management of NDO, administration of intravesicular botulinum toxin using clean intermittent catheterization decreases the incidence of urinary tract infections, promotes urinary continence, and improves quality of life for 9 months after a single injection; moreover, those benefits are maintained with repeated injections over time.
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Affiliation(s)
- Gael J Yonnet
- Department of Neurology, University of Utah, Salt Lake City, UT, USA (GJY, ASF, JWR); Neurovirology Research Laboratory, SLC-VAMC, Department of Neurology, Salt Lake City, UT, USA (NGC, JWR); and The Brain Institute, University of Utah, Salt Lake City, UT, USA (JWR)
| | - Anette S Fjeldstad
- Department of Neurology, University of Utah, Salt Lake City, UT, USA (GJY, ASF, JWR); Neurovirology Research Laboratory, SLC-VAMC, Department of Neurology, Salt Lake City, UT, USA (NGC, JWR); and The Brain Institute, University of Utah, Salt Lake City, UT, USA (JWR)
| | - Noel G Carlson
- Department of Neurology, University of Utah, Salt Lake City, UT, USA (GJY, ASF, JWR); Neurovirology Research Laboratory, SLC-VAMC, Department of Neurology, Salt Lake City, UT, USA (NGC, JWR); and The Brain Institute, University of Utah, Salt Lake City, UT, USA (JWR)
| | - John W Rose
- Department of Neurology, University of Utah, Salt Lake City, UT, USA (GJY, ASF, JWR); Neurovirology Research Laboratory, SLC-VAMC, Department of Neurology, Salt Lake City, UT, USA (NGC, JWR); and The Brain Institute, University of Utah, Salt Lake City, UT, USA (JWR)
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Repeated Injection of Botulinum Toxin a in Patients with Neurogenic Bladder: Our Experience. Urologia 2012; 79 Suppl 19:9-14. [DOI: 10.5301/ru.2012.9383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 11/20/2022]
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17
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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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Bridoux V, Gourcerol G, Kianifard B, Touchais JY, Ducrotte P, Leroi AM, Michot F, Tuech JJ. Botulinum A toxin as a treatment for overactive rectum with associated faecal incontinence. Colorectal Dis 2012; 14:342-8. [PMID: 21689287 DOI: 10.1111/j.1463-1318.2011.02585.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM Rectal hypercontractility can lead to faecal incontinence (FI). Botulinum toxin (BT) has been used successfully for the treatment of bladder overactivity. This study aimed to evaluate the therapeutic value of intrarectal injections of BT in inhibiting colorectal contractions and relieving FI in patients suffering from FI as a result of overactive rectal contractions. METHOD A prospective open study was carried out in Rouen University Hospital. Six patients (four men and two women) with severe FI related to overactive rectal contractions underwent intrarectal submucosal injections of BT placed in three rows of 10, 1-ml injections (50 U/1 ml; Dysport(®)) starting 1 cm above the dentate line and repeated twice, at intervals of 5 cm proximally. The end-points included improvement in the FI score, in faecal incontinence quality of life (FIQL) and of manometric abnormality. RESULTS All patients reported improvement in the FI score [18.2±1.1 at baseline vs 9.0±1.7 at 3 months (P=0.04)] and in FIQL. Rectal contractile activity was reduced. The frequency of contractions remained unaffected (28.1±6.6/h; P=0.46 vs baseline). High-amplitude contractions of >50 cmH(2)O were significantly decreased in all patients (16.6±3.9 vs 6.6±4.1/h; P=0.03). CONCLUSION Patients with an 'overactive rectum' are a heterogeneous group, with varying causes of dysfunction. The dose of BT used was arbitrarily selected. Nevertheless, the study introduces a further therapeutic option in the treatment of FI caused by rectal overactivity.
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Affiliation(s)
- V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex, France
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Contemporary Management of Lower Urinary Tract Disease With Botulinum Toxin A: A Systematic Review of Botox (OnabotulinumtoxinA) and Dysport (AbobotulinumtoxinA). Eur Urol 2011; 60:784-95. [DOI: 10.1016/j.eururo.2011.07.001] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 07/01/2011] [Indexed: 01/16/2023]
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Alloussi SH, Lang C, Eichel R, Al-Kaabneh A, Seibold J, Schwentner C, Alloussi S. Videourodynamic changes of botulinum toxin A in patients with neurogenic bladder dysfunction (NBD) and idiopathic detrusor overactivity (IDO) refractory to drug treatment. World J Urol 2011; 30:367-73. [DOI: 10.1007/s00345-011-0736-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 07/20/2011] [Indexed: 10/17/2022] Open
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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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Mouttalib S, Khan S, Castel-Lacanal E, Guillotreau J, De Boissezon X, Malavaud B, Marque P, Rischmann P, Gamé X. Risk of urinary tract infection after detrusor botulinum toxin A injections for refractory neurogenic detrusor overactivity in patients with no antibiotic treatment. BJU Int 2011; 106:1677-80. [PMID: 20590550 DOI: 10.1111/j.1464-410x.2010.09435.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine if antibiotic prophylaxis is required for intradetrusor botulinum toxin A (BoNT-A) injections. PATIENTS AND METHODS This was a prospective non-randomized study. Inclusion criteria were adult patients with neurogenic detrusor overactivity who failed anticholinergic-based first-line treatment and had sterile urine culture 7 days before injections, a negative dipstick test on the day of the injections, and were performing clean intermittent self-catheterization. Injections were performed using a rigid cystoscope, under local anaesthetic. Patients received BoNT-A as either Botox® (Allergan Inc., Irvine, CA, USA) 300 U in 30 sites or Dysport® (Ipsen Ltd, Ipsen, Paris, France) 750 U in 20 sites. Urine culture was done 6 days and 6 weeks after the injections. If urinary tract infection (UTI) was suspected, a physician performed a complete physical examination. The primary outcome criterion was the occurrence of UTI during the first week after injections. RESULTS In all, 42 patients (22 women, 20 men) with a mean (sd) age 45.3 (16.4) years were included. A symptomatic UTI occurred during the first week after the injections in three patients (7.1%). The urinary colonization rate was 31% and 26% at 6 days and 6 weeks after injection, respectively. The most common bacterium was Escherichia coli (62.5%). There were no differences between 20 and 30 injection sites or between the sexes. CONCLUSION The rate of UTI after intradetrusor injections of BoNT-A was 7.1%. The most frequent bacterium involved was Escherichia coli. These results indicate that antibiotic prophylaxis for intradetrusor BoNT-A injections seems necessary.
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Affiliation(s)
- Sofia Mouttalib
- Service d'Urologie, Transplantation Rénale et Andrologie Service de Médecine Physique et Réadaptation, CHU Rangueil, Toulouse, France
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Kulaksizoglu H, Parman Y. Use of botulinim toxin-A for the treatment of overactive bladder symptoms in patients with Parkinsons’s disease. Parkinsonism Relat Disord 2010; 16:531-4. [DOI: 10.1016/j.parkreldis.2010.06.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 06/10/2010] [Accepted: 06/11/2010] [Indexed: 11/26/2022]
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Grise P, Ruffion A, Denys P, Egon G, Chartier Kastler E. Efficacy and tolerability of botulinum toxin type A in patients with neurogenic detrusor overactivity and without concomitant anticholinergic therapy: comparison of two doses. Eur Urol 2010; 58:759-66. [PMID: 20674149 DOI: 10.1016/j.eururo.2010.06.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Botulinum toxin type A (BoNTA) has been reported to be effective for treatment of patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergic agents. However, in most of the studies, the efficacy was associated with concomitant use of anticholinergics. OBJECTIVE To evaluate the efficacy and tolerability of BoNTA and compare two different doses in patients with NDO without concomitant anticholinergics. DESIGN, SETTING, AND PARTICIPANTS Between 2004 and 2006, adults with NDO refractory to anticholinergics or discontinued anticholinergics due to adverse events or contraindications from four different French clinical centres were included in a prospective, randomised, double-blind, comparative trial. Inclusion criteria were urinary incontinence (UI) resulting from NDO that could not be managed with anticholinergics. Patients with bladder cancer, lithiasis, or urinary infection were excluded. INTERVENTION Patients were randomised to receive an intradetrusor injection of 500 U or 750 U of BoNTA. MEASUREMENTS The initial evaluation (ie, clinical and urodynamic variables and quality of life [QoL]) was repeated at days 30, 90, 180, and 360. Primary outcome was complete continence rate at day 30. Secondary outcomes were cumulative incontinence rate, reappearance of leakages, pad usage, urodynamics, and QoL. RESULTS AND LIMITATIONS Seventy-seven patients received 500 U (n=39) or 750 U (n=38) of BoNTA and were included in the full analysis set for efficacy analysis. Complete continence at day 30 was observed in 22 patients (56.4%) and 28 patients (73.7%) receiving 500 U or 750 U of BoNTA, respectively (p=0.056; one-sided χ(2) test to compare to α=0.025). The median delay in the reappearance of leakages was 168 d. Monotherapy of BoNTA significantly improved UI in patients with NDO. Although there was a trend towards a greater improvement with 750 U of BoNTA, no statistically significant differences in terms of clinical and urodynamic variables and QoL were found between the treatment groups. Tolerability was excellent and equivalent for both doses. CONCLUSIONS Monotherapy of BoNTA at Dysport (Ipsen, Brisbane, CA, USA) doses of 500 U or 750 U seems to be effective and well tolerated in patients with NDO.
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Affiliation(s)
- Philippe Grise
- Department of Urology, Rouen University Hospital, Rouen Cedex, France.
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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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Nikoobakht M, Daneshpajooh A, Ahmadi H, Namdari F, Rezaeidanesh M, Amini S, Pourmand G. Intraprostatic botulinum toxin type A injection for the treatment of benign prostatic hyperplasia: Initial experience with Dysport™. ACTA ACUST UNITED AC 2010; 44:151-7. [DOI: 10.3109/00365591003649201] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Azar Daneshpajooh
- Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ahmadi
- Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Namdari
- Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maedeh Rezaeidanesh
- Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Amini
- Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Pourmand
- Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Grosse J, Kramer G, Jakse G. Comparing two types of botulinum-A toxin detrusor injections in patients with severe neurogenic detrusor overactivity: a case-control study. BJU Int 2009; 104:651-6. [DOI: 10.1111/j.1464-410x.2009.08466.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Awsare NS, Jones DR. Paraplegia as a Complication of Intravesical Botulinum Toxin A (Dysport®) Injection for Overactive Bladder. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.bjmsu.2008.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ninaad S. Awsare
- Department of Urology, Royal Glamorgan Hospital, Ynysmaerdy CF72 8XR, UK
| | - David R. Jones
- Department of Urology, Royal Glamorgan Hospital, Ynysmaerdy CF72 8XR, UK
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Is efficacy of repeated intradetrusor botulinum toxin type A (Dysport®) injections dose dependent? Clinical and urodynamic results after four injections in patients with drug-resistant neurogenic detrusor overactivity. Int Urol Nephrol 2009; 41:805-13. [DOI: 10.1007/s11255-009-9528-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Accepted: 01/12/2009] [Indexed: 01/07/2023]
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Apostolidis A, Dasgupta P, Denys P, Elneil S, Fowler CJ, Giannantoni A, Karsenty G, Schulte-Baukloh H, Schurch B, Wyndaele JJ. Recommendations on the Use of Botulinum Toxin in the Treatment of Lower Urinary Tract Disorders and Pelvic Floor Dysfunctions: A European Consensus Report. Eur Urol 2009; 55:100-19. [DOI: 10.1016/j.eururo.2008.09.009] [Citation(s) in RCA: 241] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 09/08/2008] [Indexed: 01/23/2023]
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Apostolidis A, Fowler CJ. The use of botulinum neurotoxin type A (BoNTA) in urology. J Neural Transm (Vienna) 2008; 115:593-605. [PMID: 18322639 DOI: 10.1007/s00702-007-0862-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 11/08/2007] [Indexed: 11/29/2022]
Abstract
The use of Botulinum neurotoxin type A (BoNT/A) in the lower urinary tract was pioneered as early as 20 years ago with injections into the urethral sphincter reducing bladder voiding pressures, urethral pressures, and post-void residual urine. Over the past 9 years, the use of BoNT/A has revolutionised the treatment of intractable symptoms associated with the neurogenic or idiopathic overactive bladder, both in adults and children. The duration of clinical improvement is 6-11 months, is accompanied by significant amelioration of patients' quality of life and repeat bladder treatments appear to have sustained effects. Despite evidence for an effect on the afferent pathways, its mode of action in the human bladder remains largely unknown. The use of BoNT/A has also expanded into the painful bladder syndrome and in benign prostatic diseases, with promising preliminary results. This review aims to provide an insight of the use of BoNT/A in the lower urinary tract, addressing issues such as treatment outcomes and safety, mechanisms of action and potential for future research.
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Affiliation(s)
- A Apostolidis
- Institute of Neurology, University College London, London, UK.
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Jeffery S, Fynes M, Wang K, Morley R. Reply. BJU Int 2008. [DOI: 10.1111/j.1464-410x.2008.07447_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sahai A, Dowson C, Khan MS, Dasgupta P. EFFICACY AND COMPLICATIONS OF INTRADETRUSOR INJECTION WITH BOTULINUM TOXIN A IN PATIENTS WITH REFRACTORY IDIOPATHIC DETRUSOR OVERACTIVITY. BJU Int 2008; 101:515-6; author reply 516-7. [DOI: 10.1111/j.1464-410x.2008.07447_3.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jeffery S, Fynes M, Lee F, Wang K, Williams L, Morley R. Efficacy and complications of intradetrusor injection with botulinum toxin A in patients with refractory idiopathic detrusor overactivity. BJU Int 2007; 100:1302-6. [DOI: 10.1111/j.1464-410x.2007.07186.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Del Popolo G, Filocamo MT, Li Marzi V, Macchiarella A, Cecconi F, Lombardi G, Nicita G. Neurogenic detrusor overactivity treated with english botulinum toxin a: 8-year experience of one single centre. Eur Urol 2007; 53:1013-19. [PMID: 17950989 DOI: 10.1016/j.eururo.2007.09.034] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 09/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Determine long-term effect of English botulinum neurotoxin type A (BoNTA; Dysport) for refractory neurogenic detrusor overactivity (NDO) for possible reduction of BoNTA efficacy after repeated injections. METHODS Between 1999 and 2005, 199 patients with spinal cord lesions with refractory NDO were treated with Dysport. All patients underwent a clinical examination, urinalysis, and videourodynamic study at baseline and at 3, 6, and 12 mo after each treatment, as well as a visual analogue scale (VAS) assessment and a bladder diary checked for 1 wk before each visit. We used 1000, 750, 500 IU BoNTA at the beginning of our experience, and thereafter we mainly used 750 IU. Outcome measures included frequency of urge urinary incontinence (Incontinence Episode Frequency [IEF] test); urodynamic parameters including maximum cystometric bladder capacity (MCBC), reflex volume (RV), bladder compliance (BC); number of pads/condoms; antimuscarinic drug consumption; short- and long-term side-effects; and quality of life measured with VAS. RESULTS No statistically significant differences were found in efficacy duration with the three Dysport doses (p=0.5274). The difference between the intervals of injections was not statistically significant (p=0.2659). MCBC, RV, and BC improved significantly after treatment compared with baseline values (p<0.001) and there were no statistically significant differences after each retreatment or regarding Dysport dose (p>0.05). There was a significant improvement in patient satisfaction after each retreatment as expressed on the VAS (p<0.001). There was a significant reduction in IEF score and pads/condoms use in the first 4 wk after each treatment (p<0.0001). CONCLUSION After repeated injections the effect of BoNTA remained constant.
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Affiliation(s)
- Giulio Del Popolo
- Neurourology, Spinal Cord Department, Careggi University Hospital, Florence, Italy
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Abstract
PURPOSE OF REVIEW The overactive bladder is a common and distressing condition that has a significant impact on the quality of life of many people worldwide. Anticholinergics remain the first line in pharmacotherapy, however the use of these agents is hindered by adverse effects and limited efficacy. Thus there is a need for more effective treatments. Recently, there has been a move towards targeting novel pathways thought to play a role in overactivity. This review aims to provide an insight into the recent developments in pharmacotherapy of the overactive bladder. RECENT FINDINGS With recent advances in our understanding of the basic science of the overactive bladder it is becoming clear that the control of bladder functioning is far more complex than previously believed. Peripherally, a prominent role has emerged for the urothelium and the underlying suburothelium in mechanosensory control, and the role of afferent pathways in pathophysiology is increasingly recognized. SUMMARY Recent research has highlighted several potential targets for treatment of the overactive bladder, particularly within the mechanosensory pathways. With the exception of botulinum toxin, however, few new therapies have emerged showing clinical benefits. A clearer understanding of the pathophysiology of the bladder will hopefully lead to more effective and tolerated treatments.
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Affiliation(s)
- Donna J Sellers
- Biomedical Research Centre, Sheffield Hallam University, Sheffield, UK.
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Sahai A, Khan MS, Gregson N, Smith K, Dasgupta P. Botulinum toxin for detrusor overactivity and symptoms of overactive bladder: where we are now and where we are going. ACTA ACUST UNITED AC 2007; 4:379-86. [PMID: 17615549 DOI: 10.1038/ncpuro0839] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 05/08/2007] [Indexed: 11/08/2022]
Abstract
Botulinum toxin (BTX) treatment for overactive bladder and detrusor overactivity is becoming increasingly recognized as an excellent therapeutic option for treating patients refractory to anticholinergic agents. Results from open-label studies have suggested that this therapy is effective in neurogenic and idiopathic detrusor overactivity, yet validating evidence from randomized, placebo-controlled trials has been unavailable. The exact mechanism of action of BTX in the bladder is controversial, although evidence suggests that apart from preventing the presynaptic release of acetylcholine from the parasympathetic innervation to the bladder, it might have an effect on sensory mechanisms. The latter hypothesis could in part explain its effect on symptoms such as urgency. The purpose of this Review is to present the results of randomized, placebo-controlled trials in which BTX treatment for detrusor overactivity was investigated. Also the evidence supporting its potential dual mechanism of action in the bladder will be considered. In addition, the various techniques of administration of BTX are discussed and avenues for further research suggested.
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Affiliation(s)
- Arun Sahai
- Guy's, King's and St Thomas' School of Medicine, London, UK
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Update on use of botulinum toxin to treat overactive bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2007. [DOI: 10.1007/s11884-007-0002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Karsenty G, Corcos J, Schurch B, Ruffion A, Chartier-Kastler E. Chapitre C-l C - Traitement pharmacologique de l’hyperactivité détrusorienne neurologique : injections intra-détrusoriennes de toxine botulique A. Prog Urol 2007; 17:568-75. [PMID: 17622092 DOI: 10.1016/s1166-7087(07)92370-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Botulinum toxins are among the most powerful of all natural poisons. They are responsible for human botulism and constitute potential chemical weapons, but are nevertheless used as therapeutic agents in an increasing number of indications and medical specialties. Botulinum toxins were used for the first time in urology by intrasphincteric injection by Dykstra in 1988 to treat detrusor-sphincter dyssynergia in spinal cord injury patients. Schurch performed the first intradetrusor injections in 2000 to treat incontinence due to overactive bladder in adult spinal cord injury or multiple sclerosis patients. This review of the literature presents the results and level of proof for the use of botulinum toxin intradetrusor injection to treat neurogenic voiding disorders. Botulinum toxin A intradetrusor injections constitute a safe, conservative, reversible and short-term effective (6-12 months) alternative after failure of anticholinergic therapy for overactive bladder and its clinical consequences in adult spinal cord injury or multiple sclerosis patients (level 1b) and in children with neural tube defects (level 4). The efficacy of the first injection appears to be maintained at subsequent injections (up to 10 cycles) (level 4). Convergent and longer-term data are necessary to document and more clearly define the medium- and long-term efficacy profile of this approach, currently considered to be a major progress in neurourology.
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Affiliation(s)
- G Karsenty
- Service d'urologie, Centre hospitalo-universitaire de Marseille, France.
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Rapp DE, Lucioni A, Bales GT. Botulinum toxin injection: a review of injection principles and protocols. Int Braz J Urol 2007; 33:132-41. [PMID: 17488531 DOI: 10.1590/s1677-55382007000200002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2006] [Indexed: 11/22/2022] Open
Abstract
Despite the favorable outcomes seen using botulinum toxin (BTX) for voiding dysfunction using BTX, a standardized technique and protocol for toxin injection is not defined. We reviewed the current literature on intravesical BTX injection for DO (detrusor overactivity). Specific attention was placed on defining optimal injection protocol, including dose, volume, and injection sites. In addition, we sought to describe a standard technique to BTX injection.
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Affiliation(s)
- David E Rapp
- Section of Urology, Department of Surgery, University of Chicago Hospitals, Chicago, Illinois, USA.
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Tow AM, Toh KL, Chan SP, Consigliere D. Botulinum Toxin Type A for Refractory Neurogenic Detrusor Overactivity in Spinal Cord Injured Patients in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n1p11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Managing neurogenic detrusor overactivity (NDO) successfully in spinal cord-injured patients is a challenge. The aims of preserving kidney function by achieving safe bladder pressures with anticholinergic medication often leave a significant proportion of patients with side effects. Botulinum toxin type A has been shown to be a promising alternative.
Materials and Methods: Spinal cord injury patients who had NDO, on clean intermittent self-catheterisation, and were refractory to oral medications, were recruited. Three hundred units of botulinum toxin type A (Botox) in 30 mL NaCl solution were injected under cystoscopic guidance into the bladder.
Results: Fifteen patients were recruited of whom 9 were tetraplegic and 6 were paraplegic. Eleven (73.3%) had complete injuries. There was a significant reduction in the mean number of leakages from 3.75 ± 1.79 pre-injection to 0.67 ± 1.31 and 1.5 ± 1.5 at 6 and 26 weeks post-injection, respectively (P <0.05). Seventy-five per cent, 37.5% and 50% were completely dry at 6, 26 and 39 weeks post-injection, respectively. The mean maximal catheterisable volume increased from 312.3 ± 145.6 mL pre-injection to 484.6 ± 190 mL, 422.3 ± 157.3 mL and 490.0
± 230.4 mL at 6, 26 and 39 weeks post-injection, respectively (P <0.005). Maximum detrusor pressure decreased significantly from 66.3 ± 22.6 cmH2O to 21.2 ± 23.1 cmH2O and 33.6 ± 30.2 cmH2O at 6 and 26 weeks post-injection, respectively (P <0.05). The volume at which reflex detrusor contractions first occurred increased from 127.8 ± 57.5 mL pre-injury to 305.7 ± 130.8 mL at 6 weeks and 288.3 ± 13.0 mL at 26 weeks post-injection (P <0.05). Mean cysometric bladder capacity increased from 187.8 ± 69.2 mL to 305 ± 136.4 mL and 288.3 ± 13.0 mL at 6 and 26 weeks post- injury, respectively (P <0.05). Sixty per cent of patients were completely off medications at 6 and 26 weeks post-injection. One patient had urinary tract infection and 1 experienced autonomic dysreflexia during cystoscopy. Satisfaction levels increased from 4.3 ± 2.3 pre-injury to 7.2 ± 1.9 and 7.3 ± 2.3 at 6 weeks and 26 weeks, respectively. This also correlated with fewer leakages.
Conclusion: Botulinum toxin type A injected into the detrusor is safe and efficacious for spinal cord injured patients with refractory detrusor overactivity. This effect is maintained at 26 weeks post-injection.
Key words: Anticholinergics, Spinal cord injury, Urodynamics, Voiding
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Affiliation(s)
- Kyu-Sung Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Suk Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shah J, Patki P, Patil K, Wood S. WHAT IS THE OPTIMUM DOSE OF TYPE A BOTULINUM TOXIN FOR TREATING NEUROGENIC BLADDER OVERACTIVITY? BJU Int 2006; 98:466-7. [PMID: 16879701 DOI: 10.1111/j.1464-410x.2006.06408_6.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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