Short-term outcome of onabotulinumtoxin A injection for the treatment of refractory idiopathic detrusor overactivity

Abstract

Introduction There are many theories behind the etiology of refractory idiopathic detrusor overactivity (IDO), but it is generally accepted that it is caused by a combination of myogenic and neurogenic alterations. It is also believed that mucosal sensory systems make a significant contribution to the disorder as well. Intravesical botulinum toxin A (BoNT/A) prevents acetylcholine release at the neuromuscular junction, resulting in temporary chemodenervation and muscle relaxation. The aim of this work was to assessment of outcome of BoNT/A injection for the treatment of refractory IDO. Patients and methods The author included 37 patients who received intravesical BoNT/A for the treatment of refractory IDO. Of these patients, 25 had 3 years of follow-up. All patients were resistant to oral antimuscarinic therapy and/or adrenergic β3 agonists. BoNT/A was injected intra-detrusor muscle supratrigonally in aliquots of 1 ml delivering 10 units at each injection site, usually at 20 sites. Results A total of 37 patients with urgency and urge incontinent were included; of them, 22 patients had urgency incontinence and 15 patients had severe urgency without incontinence. Significant decreases in urgency incontinence episodes with BoNT/A were seen as early as week 2 (P < 0.001) and continued through week 12 (P < 0.001). Reduction in incontinence episodes was 4–8, which changed to 2–5 after injection. Moreover, 100% reduction in incontinence episodes was minimal and occurred only in 10%. Conclusion BoNT/A promotes significant improvement of urinary urgency, urinary frequency, nocturia, and incontinence symptoms. Although there is incidence of complications especially urinary retention and urinary tract infection among patients, BONT/A still is safe and tolerable.

Keywords

• detrusor overactivity
• onabotulinumtoxin a
• overactive bladder
• urgency incontinence
• urgency