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World Journal of Urology

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01-02-2017 | Original Article

Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms

Authors: T. A. T. Marcelissen, M. S. Rahnama’i, A. Snijkers, B. Schurch, P. De Vries

Published in: World Journal of Urology | Issue 2/2017

Abstract

Introduction

Intravesical botulinum toxin (BoNT-A) is a safe and effective treatment for overactive bladder syndrome. There are many reports on the clinical experience with BoNT-A, especially in patients with neurogenic detrusor overactivity. The US Food and Drug Administration has recently approved its use for idiopathic overactive bladder (iOAB). Various studies have reported positive results for iOAB in the short-term. Yet little is known about the results after repeated BoNT-A injections. In this study, we evaluated the long-term results of botulinum toxin (BoNT-A) in women with iOAB.

Methods

Patients treated with BoNT-A from 2004 until 2009 were evaluated in a non-academic teaching hospital (Zuyderland MC, Heerlen, the Netherlands). All female patients with a follow-up of >5 years with idiopathic bladder dysfunction were included. All patients received 200 U of onabotulinum toxin-A in 20 intradetrusor injections. In some patients, we applied a dose adjustment for repeated injections. Patients were instructed how to use clean intermittent self-catheterization (CISC) before the treatment. We advised patients to commence CISC if post-void residual exceeded 150 ml.

Results

A total of 128 women were included. All patients had at least 5-year follow-up after their first injection. The mean follow-up was 97 (60–125) months. The mean age was 67 (46–88) years. Of all patients, 30 % were still on BoNT-A treatment at the last follow-up visit. Of the 70 % that discontinued treatment, 27 % had insufficient effect and 43 % had tolerability issues. Most patients discontinued treatment after the first (79 %) and second (19 %) injections. Only 2 % of patients discontinued treatment after more than two injections during follow-up.

Conclusion

Intravesical BoNT-A is an effective treatment for women with idiopathic OAB. However, in time, almost two-thirds of patients in our study discontinued therapy. Most patients discontinue treatment after one or two injections and mainly due to tolerability issues.

Apostolidis A et al (2016) Do we understand how botulinum toxin works and have we optimized the way it is administered to the bladder? ICI-RS 2014. Neurourol Urodyn 35(2):293–298CrossRefPubMed

Apostolidis A, Dasgupta P, Fowler CJ (2006) Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur Urol 49(4):644–650CrossRefPubMed

Chapple C et al (2013) OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Eur Urol 64(2):249–256CrossRefPubMed

Nitti VW et al (2013) OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol 189(6):2186–2193CrossRefPubMed

Sievert KD et al (2014) OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder. Int J Clin Pract 68(10):1246–1256CrossRefPubMedPubMedCentral

Bosch JL et al (2010) What treatment should we use if drugs fail for OAB; and what really works after drugs? Neurourol Urodyn 29(4):658–661CrossRefPubMed

Makovey I et al (2011) Botulinum toxin outcomes for idiopathic overactive bladder stratified by indication: lack of anticholinergic efficacy versus intolerability. Neurourol Urodyn 30(8):1538–1540CrossRefPubMed

Liao CH, Kuo HC (2015) Practical aspects of botulinum toxin-A treatment in patients with overactive bladder syndrome. Int Neurourol J 19(4):213–219CrossRefPubMedPubMedCentral

Schurch B et al (2000) Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 164(3 Pt 1):692–697CrossRefPubMed

10.

Schurch B, Carda S (2014) OnabotulinumtoxinA and multiple sclerosis. Ann Phys Rehabil Med 57(5):302–314CrossRefPubMed

11.

Mangera A et al (2011) Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA). Eur Urol 60(4):784–795CrossRefPubMed

12.

Tubaro A, Puccini F, De Nunzio C (2015) The management of overactive bladder: percutaneous tibial nerve stimulation, sacral nerve stimulation, or botulinum toxin? Curr Opin Urol 25(4):305–310PubMed

13.

Visco AG et al (2012) Anticholinergic therapy vs. onabotulinumtoxina for urgency urinary incontinence. N Engl J Med 367(19):1803–1813CrossRefPubMedPubMedCentral

14.

Mohee A et al (2013) Long-term outcome of the use of intravesical botulinum toxin for the treatment of overactive bladder (OAB). BJU Int 111(1):106–113CrossRefPubMed

15.

Dowson C et al (2012) Repeated botulinum toxin type A injections for refractory overactive bladder: medium-term outcomes, safety profile, and discontinuation rates. Eur Urol 61(4):834–839CrossRefPubMed

16.

Veeratterapillay R et al (2014) Discontinuation rates and inter-injection interval for repeated intravesical botulinum toxin type A injections for detrusor overactivity. Int J Urol 21(2):175–178CrossRefPubMed

17.

Cruz F, Nitti V (2014) Chapter 5: Clinical data in neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). Neurourol Urodyn 33 Suppl 3:S26–S31CrossRefPubMed

18.

Khan S et al (2009) What a patient with refractory idiopathic detrusor overactivity should know about botulinum neurotoxin type a injection. J Urol 181(4):1773–1778CrossRefPubMed

19.

Sahai A et al (2010) Repeated injections of botulinum toxin-A for idiopathic detrusor overactivity. Urol 75(3):552–558CrossRefPubMed

20.

Mangera A et al (2014) An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol 65(5):981–990CrossRefPubMed

Title: Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms
Authors: T. A. T. Marcelissen
M. S. Rahnama’i
A. Snijkers
B. Schurch
P. De Vries
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 2/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1862-y

At a glance: The STEP trials

Springer Medicine

Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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