Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery

Lapitan

Neurourology and Urodynamics

et al. 2022

Purpose We sought to systematically review the literature on the use of botulinum toxin (BTX‐A) injections in the bladder to treat overactive bladder (OAB) in men. Materials and methods A systematic review was performed to identify clinical trials on efficacy and safety of BTX‐A injections in the detrusor for treatment of OAB in men published from inception to October 2020. Quality assessment was performed using the Cochrane Collaboration's tool for assessing risk of bias and study characteristics were extracted by two reviewers independently. Results After screening 75 abstracts, 12 trials were included in the qualitative synthesis, of which 6 were conducted exclusively in men (mean age: 66.7 years). Only two were randomized controlled studies and the remaining were observational studies, mostly case series. Total number of participants in each study ranged from 28 to 146. Therapeutic response to intravesical BTX‐A injection was assessed differently across the studies, which used quality‐of‐life symptom questionnaires and voiding diary parameters. Urodynamics findings were reported separately for men before and after intravesical injection of BTX‐A in two studies only. Pooling of outcome data was possible with adverse events reported after BTX‐A by seven studies, which showed urinary tract infection, urinary retention, increased postvoid residual, de novo interstitial cystitis, and hematuria rates of 29.8%, 20.0%, 37.3%, 28.3%, and 12.4%, respectively. Conclusions Limited information regarding the efficacy and safety of BTX‐A bladder injections for male OAB from relatively low evidence is available. Further research is needed to better understand the risk‐benefit profile of BTX‐A in the male population.

Section: Resultsmentioning

confidence: 99%

“…Seven studies were included in the quantitative synthesis of the adverse event rates associated with botulinum toxin. [15][16][17][18][19][20][21]…”

Section: Studies Identified By the Literature Searchmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…20 Treatment dropout rate was assessed in two studies, 21,25 reaching 69% in 43 months 25 and 70.8% in 69 months. 21…”

Section: Adverse Eventsmentioning

confidence: 99%

See 3 more Smart Citations

Botulinum toxin for treating overactive bladder in men: A systematic review

Lapitan

Neurourology and Urodynamics

et al. 2022

Neurourology and Urodynamics

Can we predict and manage persistent storage and voiding LUTS following bladder outflow resistance reduction surgery in men? ICI‐RS 2023

Tarcan,

Hashim,

Malde

et al. 2024

AimsLower urinary tract symptoms (LUTS) persist in up to 50% of patients after bladder outflow resistance reduction surgery (BORRS) in men. Our think tank aims to address the predictive factors for persistent LUTS after BORRS and to propose the recommendations for future research to enable improved better patient counseling and selection by more accurate prediction of treatment outcome.MethodsA think tank of ICI‐RS gathered in 2023, Bristol, UK, to discuss the pre and postsurgical clinical and urodynamic evaluation of men undergoing BORRS and whether it is possible to predict which men will have persistent LUTS after BORRS.ResultsOur think tank agrees that due to the multifactorial, and still not fully understood, etiology of male LUTS it is not possible to precisely predict in many men who will have persistent LUTS after BORRS. However, severe storage symptoms (overactive bladder, OAB) in association with low volume and high amplitude detrusor overactivity and low bladder capacity in preoperative urodynamics, increase the likelihood of persistent OAB/storage symptoms after BORRS. Furthermore, patients who are clearly obstructed and have good bladder contractility on preoperative pressure flow studies do better postoperatively compared to their counterparts. However, the benefit of pressure flow studies is decreased in patients who do not acceptably void during the study. Poor voiding after BORRS may occur due to persistent obstruction or detrusor underactivity.ConclusionFuture research is needed to increase our understanding of why male LUTS persist after surgery, and to enable better patient selection and more precise patient counseling before BORRS.

Precision Medical Sciences

Prostatectomy postoperative urinary incontinence: From origin to treatment

Jing,

Gu,

et al. 2023

Prostate cancer is a common malignant tumor at present, and there are still adverse reactions after radical prostatectomy. As many as 30% of patients complain of urinary incontinence (UI). This review begins with the pathophysiological basis of post‐prostatectomy urinary incontinence (PPUI) and describes the maintenance of normal urine control function, anatomical changes, and urodynamic maintenance of PPUI. Then, we talk about the various influencing factors of UI, for example, the differences caused by the basic condition of the patient, the length of the membranous urinary tract, the level of prostate‐specific antigen before operation, the method and technique of operation, and so on. Last, we introduce all kinds of treatments of PPUI in detail. It includes noninvasive conservative treatment, traditional surgical treatment, emerging stem cell therapy treatment, and postoperative psychotherapy of PPUI. The present situation of the treatment of UI after prostatectomy is summarized, and the prospect of the technology is put forward.