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World Journal of Urology

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01-05-2019 | Original Article

Modifications to Botulinum toxin A delivery in the management of detrusor overactivity recalcitrant to initial injections: a review

Authors: A. Doherty, D. B. Hennessey, J. R. Onggo, W. Ranasinghe, J. Gani

Published in: World Journal of Urology | Issue 5/2019

Abstract

Purpose

One quarter of patients will not respond to initial intra-detrusor Botulinum toxin A (BTX) injections for detrusor overactivity. Alternative treatment options include long-term catheterization, sacral neuromodulation, urinary diversion or bladder augmentation. Some of these procedures are invasive. This review explores modifications to BTX delivery that can improve outcome.

Methods

A search of Medline, Embase and Cochrane Library to December 2017 was performed according to Preferred Reporting Items for Systematic Review and Metaanalysis (PRISMA) guidelines. Search criteria included, dose escalation, increasing injection site number, trigone injection, switching preparation and alternative methods of BTX delivery.

Results

Several modifications to BTX delivery may improve response. There is moderate evidence that increasing the dose from 100 U to 200 U results in statistically better symptom control. Trigone-including injections were associated with significantly improved patient-reported symptom scores, as well as superior results in urodynamic outcomes without risking urinary retention and vesico-ureteric reflux. Switching from onabotulinum (OTA) or abobotulinum (ATA) or vice versa may also improve response in over 50% of patients as shown in limited studies. Increasing the number of injection sites is not beneficial. Indeed, decreasing the number of injections to as low as three sites does not result in decreased clinical outcomes. Injection-free delivery is associated with lower efficacy compared to conventional intradetrusor injections.

Conclusion

Before contemplating alternative treatments, practitioners can try to improve on BTX delivery. Firstly, the dose can be increased to 200 U; the trigone included in the injection sites and switching brands may also be helpful.

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Title: Modifications to Botulinum toxin A delivery in the management of detrusor overactivity recalcitrant to initial injections: a review
Authors: A. Doherty
D. B. Hennessey
J. R. Onggo
W. Ranasinghe
J. Gani
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 5/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2456-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Modifications to Botulinum toxin A delivery in the management of detrusor overactivity recalcitrant to initial injections: a review

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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