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Bensmail D, Karam P, Forestier A, Loze JY, Lévy J. Trends in Botulinum Toxin Use among Patients with Multiple Sclerosis: A Population-Based Study. Toxins (Basel) 2023; 15:toxins15040280. [PMID: 37104218 PMCID: PMC10142089 DOI: 10.3390/toxins15040280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
There are limited real-world data on the use of botulinum toxin type A (BoNT-A) in patients with multiple sclerosis (MS). Accordingly, this nationwide, population-based, retrospective cohort study aimed to describe BoNT-A treatment trends in patients with MS between 2014 and 2020 in France. This study extracted data from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d'Information, PMSI) covering the entire French population. Among 105,206 patients coded with MS, we identified those who received ≥1 BoNT-A injection, administered within striated muscle for MS-related spasticity and/or within the detrusor smooth muscle for neurogenic detrusor overactivity (NDO). A total of 8427 patients (8.0%) received BoNT-A injections for spasticity, 52.9% of whom received ≥3 BoNT-A injections with 61.9% of the repeated injections administered every 3 to 6 months. A total of 2912 patients (2.8%) received BoNT-A injections for NDO, with a mean of 4.7 injections per patient. Most repeated BoNT-A injections within the detrusor smooth muscle (60.0%) were administered every 5 to 8 months. There were 585 patients (0.6%) who received both BoNT-A injections within striated muscle and the detrusor smooth muscle. Overall, our study highlights a broad range of BoNT-A treatment practices between 2014 and 2020 in patients with MS.
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Affiliation(s)
- Djamel Bensmail
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, APHP, Université Paris-Saclay, 92380 Garches, France
- Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-Le-Bretonneux, France
| | | | | | | | - Jonathan Lévy
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, APHP, Université Paris-Saclay, 92380 Garches, France
- Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-Le-Bretonneux, France
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2
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Schulte-Baukloh H, Weiß C, Weinberger S, Hubatsch M, Schlomm T, Ralla B. Real-Time Documentation of the Effect of Onabotulinumtoxin A Detrusor Injection in OAB Patients-Preliminary Results. Toxins (Basel) 2022; 15:30. [PMID: 36668850 PMCID: PMC9863158 DOI: 10.3390/toxins15010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction: Detrusor injection with onabotulinumtoxin A (OnabotA-DI) is an established therapy for overactive bladder (OAB). Little is known about the exact onset and course of the effect in the days after the injection therapy. By using a new type of app-controlled automated diary pod, for the first time, the precise onset of the effect of OnabotA-DI can be documented in real time. Materials and methods: Patients due for OnabotA-DI were asked to document voiding 3 days before and up to 3 weeks after therapy using the Diary Pod app. The detrusor injection was performed with onabotulinumtoxin A (Botox®), 100 units, at 20 sites of the detrusor muscle in a standardized manner. Voiding on the injection day itself was not documented. Results: A total of 17 patients (15 women, 2 men; aged 33−83 (mean 64.6; median 70) years) were included in the study. The handling of the Diary Pod app was user-friendly, and elderly patients did not encounter technical problems. The results of patients with reliably documented micturitions showed a continuous reduction in micturition frequency every day from the first day and significantly from day 5. For 24 h voiding, from 12.83 ± 5.54 in the 3 days before injection, the following mean values were found with significant (p < 0.05) changes after the intervention: 9.17 ± 3.19 on day 5, 8.75 ± 3.69 on day 10, 7.17 ± 2.04 on day 15, and 5.75 ± 0.5 on day 20. These changes were in similar proportions during the daytime and nighttime. Conclusions: Contrary to previous knowledge, the effect of the OnabotA-DI set in from the first postoperative days and was reflected a similar extent in day and night micturition. This study is the first to document the onset of action of OnabotA-DI in real time.
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Affiliation(s)
| | - Catarina Weiß
- Urologic Practice, Kurfürstendamm 139, 10711 Berlin, Germany
| | - Sarah Weinberger
- Department of Urology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Mandy Hubatsch
- Department of Urology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Bernhard Ralla
- Department of Urology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
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Sharifiaghdas F, Narouie B, Rostaminejad N, Hamidi Madani M, Manteghi M, Rouientan H, Ahmadzade M, Dadpour M. Intravesical Botulinum toxin-A injection in pediatric overactive neurogenic bladder with Detrusor overactivity: Radiologic and clinical outcomes. Urologia 2022:3915603221135681. [DOI: 10.1177/03915603221135681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: The neurogenic bladder is one of the most serious and painful disorders seen in pediatric urology clinics. The upper urinary tract can be impaired by increased bladder pressure. Botulinum toxin-A (BTX-A) is one of the new therapeutic interventions for this disease. Thus, this research was designed to determine the clinical as well as radiological outcomes intravesical BTX-A injections in patients with overactive neurogenic bladder with Detrusor over activity. Patients and methods: From March 2012 to March 2019, this cohort study was conducted at Shahid Labbafinejad hospital in Tehran, Iran. Thirty-five pediatric patients with a neurogenic bladder and Detrusor overactivity who fulfilled the eligibility criteria received BTX-A injections. Demographic data, including spinal cord lesions or congenital malformations, upper and lower urinary tract nuclear scans, evidence of vesicoureteral reflux (VUR) and its severity, and hydronephrosis and 72 h voiding diary before and after intervention were all recorded. Results: The mean ± standard deviation age of participants was 9.47 ± 4.61 years. After injection, nocturia and urination frequency as general symptoms of the overactive neurogenic bladder improved ( p < 0.05). Also, the severity of hydronephrosis was decreased in 33% of patients following injection. In our study, 32 out of 35 patients had vesicoureteral reflux. Of those, there was complete resolution and downgrading of VUR in 17 (53.12%) and 13 (40.62%) respectively. Seventeen patients (53.12%) had complete recovery post-injection from VUR. Conclusion: In the evaluation of voiding cystourethrography (VCUG) before and after the injection, downgrading of VUR was seen in 53% of the cases. In the 99mTc-DMSA nuclear scan before and after the injection, the appearance of a new parenchymal scar and uptake reduction was not observed, which indicates the cessation of scar formation in all patients. Although Enuresis, Urgency, Frequency, Nocturia, and UUI significantly improved after injection.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Niloofar Rostaminejad
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hamidi Madani
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadjavad Manteghi
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Rouientan
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abreu-Mendes P, Ferrão-Mendes A, Botelho F, Cruz F, Pinto R. Effect of Intratrigonal Botulinum Toxin in Patients with Bladder Pain Syndrome/Interstitial Cystitis: A Long-Term, Single-Center Study in Real-Life Conditions. Toxins (Basel) 2022; 14:775. [PMID: 36356025 PMCID: PMC9692970 DOI: 10.3390/toxins14110775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
The high percentage of treatment failures seen in patients with bladder pain syndrome/interstitial cystitis (BPS/IC) managed conservatively frequently demands invasive treatment options. We aimed to evaluate the long-term efficacy and adverse events of intratrigonal botulinum toxin injection in such circumstances, as well as to determine possible predictors of response to toxin treatment. A retrospective cohort study included 47 female BPS/IC patients treated with onabotulinum toxin A (OnabotA) in a tertiary hospital between the years 2009 and 2022. All patients received 100 U of OnabotA in ten injections limited to the trigonal area. Patients were divided into three groups based on their treatment response as responders, non-responders and lost to follow-up due to non-medical reasons. The clinical and surgical records of the individuals were retrieved, including the 10-point visual analogue scale (VAS), the number of treatments, the time between injections, and the age at the first injection. A total of 25 patients (>50% of the cohort) were long-term responders, but none of the evaluated parameters was a predictor for this circumstance: age, pain intensity, or duration of improvement following the injection. The time between injections was stable (around 1 year). No severe adverse events were registered. The intratrigonal injection of botulinum toxin in patients with BPS/IC was an effective and safe long-term treatment for patients' refractory to conservative forms of treatment. Age, basal pain intensity, and time to injection request did not predict long-term response to OnaBotA.
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Affiliation(s)
- Pedro Abreu-Mendes
- Department of Urology, São João Universitary Hospital Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | | | - Francisco Botelho
- Department of Urology, São João Universitary Hospital Center, 4200-319 Porto, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
| | - Francisco Cruz
- Department of Urology, São João Universitary Hospital Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Rui Pinto
- Department of Urology, São João Universitary Hospital Center, 4200-319 Porto, Portugal
- Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
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Liu P, Li Y, Shi B, Zhang Q, Guo H. Comparison of different types of therapy for overactive bladder: A systematic review and network meta-analysis. Front Med (Lausanne) 2022; 9:1014291. [PMID: 36341256 PMCID: PMC9633225 DOI: 10.3389/fmed.2022.1014291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/04/2022] [Indexed: 12/02/2022] Open
Abstract
To compare the efficacy and safety of different interventions [including antimuscarinics, mirabegron, OnabotulinumtoxinA, sacral neuromodulation (SNM) and peripheral tibial nerve stimulation (PTNS)] for treating idiopathic overactive bladder (OAB). PubMed, Embase, Cochrane Library, and other sources were searched for randomized controlled trials (RCTs) comparing interventions for overactive bladder from 1 January 2000 to 19 April 2021. A systematic review and network meta-analysis were performed by two authors independently. Fifty-five RCTs involving 32,507 patients were included in this analysis. Overall, antimuscarinics, mirabegron, OnabotulinumtoxinA, sacral neuromodulation, and peripheral tibial nerve stimulation were more efficacious than placebo, and sacral neuromodulation showed the best effect for reducing micturition frequency, urgency episodes and urgency urinary incontinence episodes. OnabotulinumtoxinA was the best intervention for achieving reductions of 100 and ≥50% in the number of urinary incontinence episodes/day, and peripheral tibial nerve stimulation was the best intervention for reducing urinary incontinence episodes. Antimuscarinics, mirabegron and peripheral tibial nerve stimulation had a similar efficacy for reducing micturition frequency, urinary incontinence episodes and urgency urinary incontinence episodes. The results revealed that all interventions examined herein were efficacious for managing adult overactive bladder syndrome compared with placebo. Furthermore, sacral neuromodulation and OnabotulinumtoxinA were the most efficient treatments for overactive bladder. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251966], identifier [CRD42021251966].
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Affiliation(s)
| | | | | | - Qiujie Zhang
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hu Guo
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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6
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Norton JM, Dowling-Castronovo A, Conroy B, Hijaz A, Kim M, Loizou C, Meyer DE, Constantine ML. The Inflection Point Model: a Model to Explore the Hidden Burdens of Non-Cancerous Genitourinary Conditions. Urology 2021; 166:56-65. [PMID: 34390729 DOI: 10.1016/j.urology.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To propose a conceptual model to identify points along the condition course where actions or inaction affect downstream burdens of non-cancerous genitourinary conditions (NCGUC). MATERIALS AND METHODS The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened an interdisciplinary meeting to comprehensively consider the burdens of NCGUCs. Subsequently, the authors met monthly to conceptualize the model. RESULTS Inflection points (IP) describe time points during a condition course that are sensitive to change. Our proposed Inflection Point Model (IPM) helps conceptualize burden/benefit trade-offs in any related decision and provides a platform to identify the downstream aggregate burden of a NCGUC across multiple socio-ecological levels at a single time point, which may be summed across the condition course to measure cumulative burden. Two personae demonstrate the utility of this model to better understand impacts of two common NCGUCs. CONCLUSIONS The IPM may be applied in multiple contexts: narrowly to explore burden of a single NCGUC at a single IP; or more broadly, to address multiple conditions, multiple IPs, or multiple domains/levels of social ecology. Applying the IPM may entail combining population data describing prevalence of NCGUCs, associated behaviors, and resulting outcome patterns that can be combined with suitable mathematical models to quantify aggregate and cumulative burden. The IPM challenges stakeholders to expand from the individual to include broader levels of social ecology. Application of the IPM will undoubtedly identify data gaps and research needs that must be fulfilled to delineate and address the burden of NCGUCs.
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Affiliation(s)
- Jenna M Norton
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | | | - Britt Conroy
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Adonis Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Michelle Kim
- Department of Urology, Massachusetts General Hospital, Harvard Medical School Boston, Boston, MA
| | | | - David E Meyer
- United States Environmental Protection Agency, Office of Research and Development, Center for Environmental Solutions and Emergency Response, Cincinnati, OH
| | - Melissa L Constantine
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
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7
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Zeitouni L, Rahman M, O’Hare K, Warren H, Pinto T, Hammadeh MY. Multifocal bladder nephrogenic adenoma following repeated intravesical onabotulinumtoxinA (Botox ®) injection for refractory overactive bladder. Case report and literature review. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211025915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Layla Zeitouni
- University of Glasgow, School of Medicine, Dentistry and Nursing, UK
| | | | - Kim O’Hare
- Histopathology Department, Lewisham and Greenwich NHS Trust, UK
| | - Hannah Warren
- Urology Department, Lewisham and Greenwich NHS Trust, UK
| | - Thelma Pinto
- Urology Department, Lewisham and Greenwich NHS Trust, UK
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8
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Ton J, Downing P, Versi E, van Uem S, Ephraim S, Murphy M, Lucente V. Outcomes of a single trigone-only vs. 20 trigone-sparing injections of OnabotulinumtoxinA for refractory overactive bladder (OAB). Int Urol Nephrol 2021; 53:1067-1072. [PMID: 33742316 DOI: 10.1007/s11255-021-02802-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare the safety and durability of a single intravesical trigonal-only versus 20 trigone-sparing injections of OnabotulinumtoxinA (BTA) for refractory OAB. METHODS A chart review of all idiopathic OAB patients treated with BTA from January 2016 to December 2018 was performed. Outcomes measures included: inter-injection interval, post-void residual (PVR), urinary tract infections (UTI), urinary retention requiring catheterization, and procedure time (min). Statistical analyses were performed using independent sample t-tests. RESULTS Baseline characteristics were comparable for the two groups, data on 69 treatments (19 patients trigone-only) were compared to 105 treatments (26 patients trigone-sparing). There were no differences in the inter-injection intervals or rates of UTI. The trigone-only group exhibited a lower mean PVR (113 ml vs 160 ml, p < 0.02), lower proportion with PVR > 150 ml (23% vs. 39%, p < 0.03), lower rate of urinary retention (5.3% vs. 17.4%, p < 0.02), and shorter procedure time (4.3 min vs. 5.7 min, p < 0.01). There were no cases of vesico-ureteral reflux. CONCLUSION While interpretation remains speculative, the results of this observational study suggest that a single trigone-only injection appears to be as safe and durable as multiple trigone-sparing injections but maybe quicker to perform and appears to have a lower impact on voiding function. Larger series and adequately powered prospective randomized clinical trials are warranted to validate the findings of this pilot study.
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Affiliation(s)
- Jessica Ton
- Anne Arundel Medical Center, Annapolis, MD, USA
| | | | - Eboo Versi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Stefanie van Uem
- Department of Urology, Stanford University School of Medicine, San Francisco, USA
| | | | - Miles Murphy
- Institute for Female Pelvic Medicine, Allentown, PA, USA
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9
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Timm B, Jayarajan J, Chan G, Bolton D. Botox rechallenge-An additional tool in the management of an incompletely emptying bladder and inadequate overactive symptom control following sacral neuromodulation. Low Urin Tract Symptoms 2020; 13:194-197. [PMID: 32548938 DOI: 10.1111/luts.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022]
Abstract
Two female patients aged 70 and 72 with video-urodynamics-confirmed detrusor overactivity and detrusor underactivity (DO-DU) were treated. Patients were refractory to medical therapies and had previously failed intravesical botulinum toxin type A (BoNT-A) at other centers secondary to urinary retention and difficulty with self-catheterization. Placement of an Interstim II device (Medtronic, Minneapolis, Minnesota) for sacral neuromodulation (SNM) as alternative third-line treatment partially improved overactive bladder (OAB) symptoms while significantly improving voiding symptoms. Postvoid residual (PVR) of patients improved from a median of 118 mL (110-125 mL) to 20 mL (18-26 mL) and 213 mL (195-230 mL) to 70 mL (60-73 mL), respectively. Addition of medical therapies post SNM failed to modify OAB symptoms further and a rechallenge with dose-reduced BoNT-A was undertaken.OAB symptoms were significantly improved by addition of BoNT-A, while urinary retention was avoided (median PVR post BoNT-A 38 mL [34-40 mL] and 185 mL [150-205 mL], respectively). Reduction in incontinence pad use as well as resolution of nighttime incontinence in both patients and daytime incontinence in one patient was achieved. DO-DU patients treated by SNM who have improved bladder emptying (PVR <100 mL) but incomplete resolution of OAB symptoms should be trialed on adjunct medical therapies to improve OAB symptoms. If OAB symptoms are still inadequately controlled, consideration of a rechallenge with BoNT-A, particularly with dose reduction, appears to be efficacious and avoids symptomatic retention in this challenging cohort.
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Affiliation(s)
- Brennan Timm
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia.,North Eastern Urology, Heidelberg, Victoria, Australia
| | - Jyotsna Jayarajan
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia.,North Eastern Urology, Heidelberg, Victoria, Australia
| | - Garson Chan
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
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Jensen DB, Klingenberg S, Dimintiyanova KP, Wienecke J, Meehan CF. Intramuscular Botulinum toxin A injections induce central changes to axon initial segments and cholinergic boutons on spinal motoneurones in rats. Sci Rep 2020; 10:893. [PMID: 31964988 PMCID: PMC6972769 DOI: 10.1038/s41598-020-57699-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/30/2019] [Indexed: 01/29/2023] Open
Abstract
Intramuscular injections of botulinum toxin block pre-synaptic cholinergic release at neuromuscular junctions producing a temporary paralysis of affected motor units. There is increasing evidence, however, that the effects are not restricted to the periphery and can alter the central excitability of the motoneurones at the spinal level. This includes increases in input resistance, decreases in rheobase currents for action potentials and prolongations of the post-spike after-hyperpolarization. The aim of our experiments was to investigate possible anatomical explanations for these changes. Unilateral injections of Botulinum toxin A mixed with a tracer were made into the gastrocnemius muscle of adult rats and contralateral tracer only injections provided controls. Immunohistochemistry for Ankyrin G and the vesicular acetylcholine transporter labelled axon initial segments and cholinergic C-boutons on traced motoneurones at 2 weeks post-injection. Soma size was not affected by the toxin; however, axon initial segments were 5.1% longer and 13.6% further from the soma which could explain reductions in rheobase. Finally, there was a reduction in surface area (18.6%) and volume (12.8%) but not frequency of C-boutons on treated motoneurones potentially explaining prolongations of the after-hyperpolarization. Botulinum Toxin A therefore affects central anatomical structures controlling or modulating motoneurone excitability explaining previously observed excitability changes.
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Affiliation(s)
- D B Jensen
- Department of Neuroscience, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen, Denmark
| | - S Klingenberg
- Department of Neuroscience, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen, Denmark
| | - K P Dimintiyanova
- Department of Neuroscience, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen, Denmark
| | - J Wienecke
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, DK-2200, Copenhagen, Denmark
| | - C F Meehan
- Department of Neuroscience, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen, Denmark.
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Abstract
Most of us live blissfully unaware of the orchestrated function that our internal organs conduct. When this peace is interrupted, it is often by routine sensations of hunger and urge. However, for >20% of the global population, chronic visceral pain is an unpleasant and often excruciating reminder of the existence of our internal organs. In many cases, there is no obvious underlying pathological cause of the pain. Accordingly, chronic visceral pain is debilitating, reduces the quality of life of sufferers, and has large concomitant socioeconomic costs. In this review, we highlight key mechanisms underlying chronic abdominal and pelvic pain associated with functional and inflammatory disorders of the gastrointestinal and urinary tracts. This includes how the colon and bladder are innervated by specialized subclasses of spinal afferents, how these afferents become sensitized in highly dynamic signaling environments, and the subsequent development of neuroplasticity within visceral pain pathways. We also highlight key contributing factors, including alterations in commensal bacteria, altered mucosal permeability, epithelial interactions with afferent nerves, alterations in immune or stress responses, and cross talk between these two adjacent organs.
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Affiliation(s)
- Luke Grundy
- Visceral Pain Research Group, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia 5042, Australia; .,Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia
| | - Andelain Erickson
- Visceral Pain Research Group, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia 5042, Australia; .,Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia
| | - Stuart M Brierley
- Visceral Pain Research Group, College of Medicine and Public Health, Centre for Neuroscience, Flinders University, Bedford Park, South Australia 5042, Australia; .,Centre for Nutrition and Gastrointestinal Diseases, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia
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12
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Brennan A, Hickey M. Botulinum toxin in women’s health: An update. Maturitas 2019; 119:21-24. [DOI: 10.1016/j.maturitas.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022]
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Mühlstädt S, Mischner S, Kranz J, Anheuser P, Mohammed N, Steffens JA, Fornara P. Quo Vadis Botulinum Toxin: Normative Constraints and Quality of Life for Patients With Idiopathic OAB? Front Surg 2018; 5:61. [PMID: 30386782 PMCID: PMC6198085 DOI: 10.3389/fsurg.2018.00061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/14/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Idiopathic overactive bladder (iOAB), with or without urge incontinence (UI), has significant psychosocial effects on patients' quality of life (QoL). The first choice of treatment for iOAB is anticholinergics and, alternatively, the β-3-adrenoceptor agonist mirabegron. However, systemic side effects and contraindications should be considered for both medications. Objective: We report the efficacy, safety and effects on QoL of botulinum toxin therapy (onabotulinum toxin type A, BOTOX®, Allergan) among patients with iOAB ± UI. Patients and Methods: Between 2005 and 2013, 51 patients were treated with onabotulinum toxin A (100 units). The inclusion criteria were the presence of confirmed iOAB ± UI with previous use of anticholinergic medication. Micturition frequency, pad count, postvoid residual volume and QoL were evaluated using two validated questionnaires [the Client Satisfaction Questionnaire-8 (CSQ-8) and the King's Health Questionnaire (KHQ)]. Statistical analysis was performed with SPSS 24.0 (p < 0.05). Results: After botulinum toxin injection, a significant improvement in iOAB ± UI symptoms was observed. The micturition frequency decreased from 10.4 ± 0.5 to 5.2 ± 0.4 micturitions per day (p = 0.026), and the pad count decreased from 3.6 ± 1.0 to 1.2 ± 0.3 pads per day (p = 0.033). Anticholinergics were not used during the administration of botulinum toxin therapy. Complications and postoperative need for intermittent self-catheterization (ISC) were not observed. Overall, 72 and 24% of patients reported being “satisfied” or “very satisfied” with the treatment. Additionally, 66% of patients would choose botulinum toxin again for the treatment of iOAB. Conclusion: Botulinum toxin therapy is an efficient, safe, and life-improving treatment for iOAB.
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Affiliation(s)
- Sandra Mühlstädt
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Shahidul Mischner
- Department of Orthopaedics, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany
| | - Jennifer Kranz
- Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Clinic, Hamburg, Germany
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Joachim A Steffens
- Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
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What is the ideal antibiotic prophylaxis for intravesically administered Botox injection? A comparison of two different regimens. Int Urogynecol J 2018; 30:701-704. [PMID: 30074062 DOI: 10.1007/s00192-018-3721-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Onabotulinum toxin A (Botox®) administered intravescially is an effective treatment for idiopathic detrusor overactivity, of which urinary tract infections (UTIs) are a common complication. The purpose of this study was to compare two prophylactic antibiotic regimens with the goal of decreasing UTI rates following intravesically administered Botox® injection. MATERIALS AND METHODS A retrospective review of two groups of patients undergoing intravesically administered Botox® injections was performed-one with idiopathic and one with neurogenic detrusor overactivity. One group received a dose of ceftriaxone intramuscularly (IM) at the time of Botox® injection, and a second group received a 3-day course of a fluoroquinolone orally starting the day before the procedure. The rate of postprocedure UTI was examined using a χ2 test. A secondary analysis was performed using logistic regression modeling to test the association between clinical characteristics and antibiotic regimen and risk of postprocedure UTIs. RESULTS Botox® injections were performed on 284 patients: 236 received a single dose of ceftriaxone IM and 48 received 3 days of a fluoroquinolone orally. The UTI rate was significantly lower in the fluoroquinolone group (20.8%) vs. the cephalosporin group (36%), p = 0.04. Predictors of postprocedure UTIs included single dose of antibiotics IM [odds ratio (OR 2.80, p = 0.02] and a positive preprocedure urine culture (OR 1.31, p = 0.03). CONCLUSIONS We found a significantly lower rate of UTIs when patients received a 3-day course of a fluoroquinolone orally as opposed to a single dose of a third-generation cephalosporin IM. Patients with a positive preprocedure culture might benefit from an even longer duration of antibiotics at the time of Botox® injection.
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The Non-neurogenic Overactive Bladder: an Update. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
The term OAB (overactive bladder) describes a symptom complex. Therefore, initial treatment should be based on clinical symptoms and the results of basic diagnostics. Patient preference is essential for the choice of the initial treatment. Behavioural therapy, electrostimulation and medical treatment are available treatment options. If these are not effective, extended diagnostic examinations should be performed prior to minimally invasive treatments, like onabotulinumtoxin injections in the detrusor or sacral neuromodulation. Surgical interventions like augmentation cystoplasty are rarely required today.
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Araklitis G, Cardozo L. Safety issues associated with using medication to treat overactive bladder. Expert Opin Drug Saf 2017; 16:1273-1280. [PMID: 28889761 DOI: 10.1080/14740338.2017.1376646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The mainstay of overactive bladder treatment is the use of anticholinergic medication with its common side effects well known. This review focused on three less well-known safety issues when treating OAB. Areas covered: Patients with increased anticholinergic load are at risk of cognitive decline, dementia or even death. The elderly are particularly at risk due to polypharmacy. Botulinum toxin carries the risk of high urinary residuals, urinary tract infection and need to self catheterise. The use of vaginal oestrogens may improve OAB symptoms, but there is concern in those with a history of breast cancer. Studies have shown that the systemic absorption is negligible and does not increase the risk of recurrence. Expert Opinion: Improvement in assessing anticholinergic load is needed with the development of a universal drug scale. To avoid increasing load, Mirabegron or botulinum toxin can be used instead. There is no consensus of the use of prophylactic antibiotics when injecting botulinum toxin and at what residual to initiate self catheterisation. Despite evidence showing that the use of vaginal oestrogens is safe in those with a history of cancer, it is not fully supported by any health body. Further work is needed in those using aromatase inhibitors.
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Affiliation(s)
- George Araklitis
- a Department of Urogynaecology , King's College Hospital , London , UK
| | - Linda Cardozo
- a Department of Urogynaecology , King's College Hospital , London , UK
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