Effect of botulinum toxin type A on idiopathic and neurogenic detrusor overactivity
Vpliv toksina botulina na idiopatski in nevrogeni čezmerno aktivni sečni mehur

english

2010

volume 79, issue 6

Autonomic Dysreflexia   Botulinum Toxin Type A   Costs and Cost Analysis   therapy   Urinary Bladder, Neurogenic   Urinary Bladder, Overactive   Urinary Incontinence

Slovensko zdravniško društvo
(Obvezni izvod spletne publikacije)

Objectives: Intra-detrusor botulinum toxin type A injection treatment for detrusor overactivity conditions, where anticholinergic medication fails, has been available as standard treatment in our institution since 2004. Efficacy, indications and pitfalls were assessed, and thoughts on safety and cost-related aspects of this treatment presented. Methods: Retrospective study analyzed eleven consecutive patients (8 with neurogenic detrusor overactivity and 3 with idiopathic detrusor overactivity), treated between 2004 and 2008. All patients were incontinent. Complete urodynamic investigation was performed before and 16 weeks after treatment. Injections of 500U of Dysport in a concentration of 25 U/ml were performed under local anesthesia as an outpatient procedure in most cases. Results: Intra-detrusor botulinum injections alleviated all overactive bladder symptoms and improved urodynamic parameters. In a patient with tetraparesis, autonomic dysreflexia, associated with detrusor overactivity that manifested as hypertensive crisis during voiding, disappeared on the third day of treatment. Complete dryness was achieved in 10/11 patients (91 %) while incontinence grade in the remaining patient decreased. One of idiopathic patients who voided spontaneously before treatment had to start self catheterization sixth day after treatment. Satisfaction on a 5 point scale increased from 1,2 before treatment to 3,5 after treatment (p<0,001). 9/11 patients (82 %) claimed that they would have treatment again when/if its effect diminished. In our health system, the treatment with Dysport is not more expensive compared to oral anticholinergic medications available. Conclusions: Botulinum is a major treatment option in patient with intractable symptoms of overactive bladder or those unable to tolerate anticholinergic medications.

23.06.2011