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Long‐term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity
Author(s) -
Joussain Charles,
Popoff Mélanie,
Phé Véronique,
Even Alexia,
Bosset PierreOlivier,
Pottier Sandra,
Falcou Laetitia,
Levy Jonathan,
Vaugier Isabelle,
Chartier Kastler Emmanuel,
Schurch Brigitte,
Denys Pierre
Publication year - 2018
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23352
Subject(s) - medicine , refractory (planetary science) , confidence interval , clinical endpoint , proportional hazards model , univariate analysis , multivariate analysis , surgery , clinical trial , physics , astrobiology
Aims Aims of this study were to assess the long‐term outcomes of Intradetrusor injection of OnabotulinumtoxinA (Botox® injection) associated with clean intermittent‐catheterization (CIC) for the treatment of neurogenic detrusor overactivity (NDO) and to identify risk factors for failure. Methods Neurological patients with NDO using CIC who had received Botox® injections between January 2001 and September 2013 were included. Clinical, urodynamic and radiological data were recorded. Primary endpoint was failure and withdrawal rates after 3, 5, and 7 years of management. Survival curves of withdrawals and failures of treatment were calculated with a 95‐confidence interval using the Kaplan‐Meier method. Risk factors for failure were determined with univariate analysis and multivariate analysis using Cox model. Results Overall, 292 patients, mean age of 40 ± 13, 6 years, were included. Overall, 219 patients (80.6%; IC95% [76.3‐85.4%]) were still treated with Botox® injections after 3 years, 128 (71.1%; IC95% [65.7%, 76.9%]) after 5 years, and 58 (60.8%, IC95% [54.0%, 68.4%]) after 7 years. Failure rate was 12.6% (IC95% [8.6‐16.5%]) after 3 years, 22.2% (IC95% [16.6‐27.3%]) after 5 years, and 28.9% (IC95% [21.9%; 35.3%]) after 7 years of follow‐up. Withdrawal rate after 7 years of follow‐up was 11.3% ( n = 33/292). Severe NDO at baseline appears to be a significant risk factor for failure. Conclusion This study confirms long‐term efficacy and tolerance of Botox® injection in patients with NDO using CIC. Long‐term failure and withdrawal rates remain low but significant, and need to be managed.