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Efficacy and complications of intradetrusor injection with botulinum toxin A in patients with refractory idiopathic detrusor overactivity
Author(s) -
Jeffery Stephen,
Fynes Michelle,
Lee Frank,
Wang Kate,
Williams Lin,
Morley Roland
Publication year - 2007
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2007.07186.x
Subject(s) - medicine , refractory (planetary science) , trigone of urinary bladder , overactive bladder , visual analogue scale , botulinum toxin , prospective cohort study , adverse effect , urology , anesthesia , surgery , urinary bladder , physics , alternative medicine , pathology , astrobiology
OBJECTIVES To evaluate the efficacy and complications of botulinum A toxin (Dysport, Ipsen Ltd, Slough, UK) 500 U in refractory idiopathic detrusor overactivity (IDO). PATIENTS AND METHODS In a prospective study of 25 patients with refractory IDO, the baseline evaluation included an assessment of symptoms, a 7‐day voiding diary, 24‐h pad test, record of symptoms on a visual analogue scale (VAS) (0–10), the Kings Health Questionnaire (KHQ) and urodynamics. Dysport 500 U was administered at 20 sites in the bladder, sparing the trigone. Patients were followed at 6 weeks and 3, 6 and 9 months; the urodynamic assessment was repeated at 3 months. RESULTS Fifteen (63%) patients reported being continent from 1 week after treatment; at 3 months, six (32%) ( P = 0.01) patients were still dry, remaining so at 6 months ( P = 0.025). Weekly leakage episodes decreased from 5.5 to 1.8 ( P = 0.044) at 6 weeks and this was sustained, at 2.7 episodes ( P = 0.012), at 9 months. The mean VAS score (0–10) decreased from 8.3 to 5.0 ( P = 0.001) at 1 week, to 5.0 at 6 weeks ( P = 0.001) and 3 months ( P = 0.03) and to 6.1 ( P = 0.013) at 6 months. On the KHQ there was a significant improvement in the severity measures domain ( P = 0.021) and incontinence impact domain ( P = 0.015) up to 9 months. The volume at first desire to void increased from 177 to 251 mL ( P = 0.04) at 3 months. At 6 weeks and 3 months, 35% of patients required catheterization, as did 22% at 6 months, but only one at 9 months. CONCLUSIONS Intradetrusor Dysport 500 U was associated with significant subjective and objective improvements in refractory IDO. The present patients initially had a significant increase in voiding dysfunction that resolved by 9 months.