Open AccessTechnical aspects of botulinum toxin type A injection in the bladder to treat urinary incontinence: reviewing the procedure
Author(s) -
Karsenty G.,
Baverstock R.,
Carlson K.,
Diaz D. C.,
Cruz F.,
Dmochowski R.,
Fulford S.,
Giannantoni A.,
Heesakkers J.,
Kaufmann A.,
Peyrat L.,
Thavaseelan J.,
Dasgupta P.
Publication year - 2014
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.12360
Subject(s) - medicine , overactive bladder , trigone of urinary bladder , urinary incontinence , urology , botulinum toxin , urinary bladder , adverse effect , perforation , surgery , pathology , materials science , alternative medicine , punching , metallurgy
Summary Aims Standardise the injection technique with botulinum toxin type A (BoNT A) in the bladder of patients with overactive bladder (OAB) [idiopathic overactive bladder ( iOAB ) or neurogenic overactive bladder ( nOAB ) with urinary incontinence], using a literature review and a survey of an International expert panel. Methods PubMed literature searches of BoNT A in adults with iOAB / nOAB together with a survey of 13 experts from 10 countries. Results Data from 21 articles and completed questionnaires were collated. The procedure can be carried out in an out‐/inpatient setting. Dose used in clinical studies vs. clinical practice was 300 and 200 U for nOAB and 200 and 100 U for iOAB . Recent studies have also demonstrated that there are no clinically relevant benefits between 100 and 150 U in iOAB or between 300 and 200 U in nOAB , though adverse effects are increased with higher doses. Usually, 30 sites for nOAB (range: 6.7–10 U/ml) and 20–30 sites for iOAB (range: 5–10 U/ml) are injected in clinical studies vs. 20–30 sites of 1 ml/injection for 200 U in nOAB and 10–20 sites of 0.5–1 ml/injection for 100 U in iOAB in clinical practice. BoNT A is usually injected directly into the detrusor, sparing the trigone. Flexible or rigid cystoscopes are used. The needle should be typically 22–27 gauge and 4 mm in length and should have a stopper to avoid any leakage or perforation of the bladder wall while ensuring a targeted injection. Conclusion Based on the literature and survey analysis, recommendations are proposed for the standardisation of the injection procedure.