Role of botulinum toxin-A in management of refractory idiopathic detrusor overactive bladder: Single center experience

Abstract

BackgroundOveractive bladder (OAB) is a bothersome condition affecting the quality of life, financial constraint on the individual, and community. Anticholinergic drugs cannot be used for long term due to adverse side effects. Botulinum toxin has recently shown promising and encouraging result in management of OAB.AimAim was to study the safety, efficacy, tolerability, and duration of effect of 200 units of botulinum toxin in refractory idiopathic detrusor overactivity.Materials and MethodsThirty-nine female patients (average age of 52 years) clinically and urodynamically diagnosed as idiopathic OAB were injected 200 units of botulinum toxin-A mixed with 20 ml of normal saline, intradetrusally at the rate of 1 mL at each site for 20 such sites sparing the trigone and ureteric orifices. Follow up at 3rd, 6th, 9th, and 12th month with clinical and urodynamical questionnaire was done.ResultsThere were 4 dropouts and 35 patients were evaluated, of which 30 patients (85.7%) showed improvement in clinical features like frequency, urgency, nocturia, and incontinence within 1 week of injection, which lasted for mean period of 7 months (varying from 6 to 9 months). Volume at first desire to void improved from median baseline of 104-204 ml and maximum cystometric capacity of bladder increased from mean baseline value of 205-330 ml. The detrusor pressure decreased by 49% from the baseline and postresidual urine volume increased by 30% of maximum cystometric capacity of bladder. There was no adverse effect on our patient.ConclusionIntradetrusor injection of Botox-A in management of refractory overactive idiopathic bladder is not only safe and well tolerated, but also very effective with practically no side effects.

Patient-Reported Side Effects of Intradetrusor Botulinum Toxin Type A for Idiopathic Overactive Bladder Syndrome

“…In all cases, the symptoms were mild and patients needed no further investigation or treatment. Impaired vision disappeared after a mean of 5 days (range [3][4][5][6][7][8][9][10][11][12][13][14] and eyelid weakness after a mean of 17 days (range 3-41). There was no statistically significant correlation between impaired vision (p = 0.238) or eyelid weakness (p = 0.359) and the injected dose.…”

The Use of Botulinum Toxin A in Idiopathic Overactive Bladder Syndrome

“…Those studies that reported urgency found a 70.5% (63%-78%) reduction in urgency episodes, and on average, 62% of the patients had no evidence of urgency after a single injection of BTX-A [12,14,[22][23][24]. The single RCT that reported urgency found that BTX-A decreased urgency episodes from 11.69 to 2.48, compared to placebo, which only showed a decrease from 7.31 to 6.02 [12].…”

“…This also was accompanied by a decrease in the Pdet max from 63 cm H 2 O to 31 cm H 2 O. First desire to void occurred on average 69 mL later than before BTX-A injection [12,14,[22][23][24].…”

“…Investigators have found a 72% (51%-91%) reduction in the number of incontinent episodes that patients experience after injection [9•, 11•, 12, 14, 23]. Furthermore, 63% of patients report complete continence after a single injection [22][23][24][25]. More objective measurements have seen a 40% decrease in pad weight and a decrease from 5 pads/day to 1.5 pads/day after BTX-A treatment [11•, 14, 22].…”

Impact of Antioxidants on Conventional and Advanced Sperm Function Parameters: An Updated Review

“…Lycopene was shown to significantly improve sperm concentration and motility in two reports that included patients with idiopathic OAT [ 37 , 38 ].…”