Eight-Year Experience With Botulinum Toxin Type-A Injections for the Treatment of Nonneurogenic Overactive Bladder: Are Repeated Injections Worthwhile?

Abstract

Purpose:To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drug-refractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome.Methods:Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson’s chi-square tests.Results:Fifty-two patients with a mean age of 67.4 years (range, 26–93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9–101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥70 years) and younger (<70 years) patient cohorts.Conclusions:Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.

OnabotulinumtoxinA in the treatment of overactive bladder: a cost-effectiveness analysis versus best supportive care in England and Wales

“…If these data become available, they could be incorporated into an updated model. A second limitation is that the results from some investigator-led onabotulinumtoxinA studies, with follow-up of up to 8 years, could not be included in the analysis [17]. Although discontinuation rates were modelled using a retrospective analysis with a median follow-up of 38 months [10], other studies were not included because of differences in study design (e.g.…”

“…OnabotulinumtoxinA was administered in the hospital outpatient setting; the cost of administration included a prophylactic course of antibiotics. In the month before retreatment, it was assumed that 15 % of patients receiving onabotulinumtoxinA would be prescribed an anticholinergic [17]. Of the patients who received BSC, 60 % used anticholinergic therapy continuously.…”

Intravesical Injection of Botulinum Toxin Type A in Patients with Refractory Overactive Bladder—Results between Young and Elderly Populations, and Factors Associated with Unfavorable Outcomes

“…The efficacy of intravesical injection of botulinum toxin type A (BoNT-A) has been established for patients with OAB who have an insufficient response to first-line pharmacological agents [ 26 , 27 ]. However, most of these published data did not focus on the elderly population, and only a handful of studies included a population with a mean age of ≥65 years old [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. In addition, 75 years of age has been proposed as a new cutoff value to redefine the elderly because of the global extension of life expectancy [ 36 ].…”