Botulinum toxin therapy for nonneurogenic overactive bladder: first experience

Aušra ČERNIAUSKIENĖ, Feliksas JANKEVIČIUS

Abstract


The paper presents early experience in the treatment of 20 patients with botulinum toxin injections into the detrusor muscle for the treatment of non-neurogenic overactive bladder (OAB) resistant to anticholinergic drugs.
Background. Botulinum toxin, a presynaptic neuromuscular blocking agent, reduces the involuntary bladder contractions that cause urgency, frequency and urge incontinence. We present our early experience with Dysport® injections into the detrusor for the treatment of non–neurogenic overactive bladder (OAB) resistant to anticholinergic drugs.
Materials and methods. Using intravenous anaesthesia, 20 patients (18 female and 2 male) with non-neurogenic OAB were injected with botulinum toxin A (Dysport®250 IU diluted in 4 ml normal saline) under cystoscopic visualization in 20 sites in the detrusor muscle, sparing the trigone. The urethral catheter was removed 24 hours after the procedure. Follow-up at 3 and 6 months after the injection included the Urogenital Distress Inventory UDI-6, the Incontinence Impact Questionnaire IIQ-7, clinical parameters and ultrasound measurement of bladder capacity and post-void residual urine volume.
Results. All 20 patients completed questionnaires and were examined after 3 and 6 months. At the 3-month follow-up, the median daytime micturation frequency decreased from 10.4 to 4.6 times (p < 0.0001) and at the 6 months follow-up 5 times (p < 0.0001), while nocturia decreased from 4.2 to 1.3 times after 3 months (p < 0.0001) and after 6 months to 2 times (p < 0.0001). Urgency decreased from 6 to 1.5 times after 3 months (p < 0.0001) and to 2 times after 6 months (p < 0.0001), and incontinence decreased from 4.2 times to 1.5 times after 3 months (p < 0.0001) and to 2.1 times after 6 months (p < 0.0001). The median maximum bladder capacity increased from 250 to 420 ml after 3 months (p < 0.0001) and decreased to 350 ml after 6 months (p < 0.0001). The post-void median residual urine volume was 10 ml. Only one patient mentioned a post-operative obstructive voiding difficulty. Eighteen (90%) patients were satisfied with the treatment. In two patients (10%), the amelioration of symptoms lasted for one month only, and later OAB symptoms
reappeared. Analysis of the UDI-6 and IIQ-7 questionnaires revealed that botulinum toxin A intradetrusor injection had decreased discomfort for patients and ameliorated their quality of life.
Conclusions. Botulinum toxin A injections in the detrusor are effective for the treatment of non-neurogenic OAB. Botulinum toxin A injections are a minimally invasive therapy and offer an alternative treatment for non–neurogenic OAB dysfunction resistant to conservative treatment. The durability of the treatment effect is the objective of the further investigation.

Keywords: botulinum toxin, overactive bladder, urinary incontinence

Full Text:

PDF


DOI: https://doi.org/10.6001/actamedica.v18i3.1825

Refbacks

  • There are currently no refbacks.


ISSN 1392-0138 (Print)
ISSN 2029-4174 (Online)