Background Aim was to investigate the association between quality of life (QoL), bowel anatomy, and the need for home parenteral support (HPS) volume in patients with nonmalignant short‐bowel syndrome (SBS) and intestinal failure (IF). Methods The SBS‐QoL scale was used in a cross‐sectional study of 95 nonmalignant SBS‐IF patients. Sum QoL scores (0: best, 170: worst) were calculated. Patients were defined as having a small bowel (≤200 cm), and patients with jejunostomy or ileostomy were subclassified based on functional small‐bowel length (cm) into 4 anatomy subgroups: 1a–1d (0–49, 50–99, 100–149, 150–200 cm, respectively). Multiple linear regression analyses explored associations between QoL, patient groups, and HPS volume, adjusting for age, sex, body mass index, and education. Results Complete data were obtained from 60 patients. HPS volume was associated with a worse SBS‐QoL score (L/d, β = 7.91; SE = 3.90; P = .048), but male sex associated with improvement (β = −26.28; SE = 11.06; P = .021). No differences in sum QoL were seen between the benign SBS‐IF subgroups 1a–d (P = .210). Multivariate regression analyses showed that patients with a small‐bowel stoma, a small‐bowel length <50 cm was associated with a significantly worse/higher SBS‐QoL score compared with a length >50 cm. Conclusion In patients with benign SBS‐IF, high HPS volume was associated with poor QoL. Also, jejunostomy or ileostomy with small‐bowel length <50 cm was associated with impaired QoL. These findings support rehabilitation strategies that reduce fecal losses and decrease HPS needs.

Botulinum toxin (BT) is a potent presynaptic neuromuscular blocking agent which induces selective, reversible muscle weakness for months when injected intramuscularly. During recent years BT has revolutionized the treatment of previously intractable symptoms of detrusor overactivity. Based on a systematic search of the PubMed database, a review of the current literature on the use of onabotulinum toxin A (Botox®) in the treatment of neurogenic detrusor overactivity is presented.Onabotulinum toxin A proved to be highly effective in the majority of studies, even though a wide range of injection techniques and dosages were described. The onset of the effect usually appeared before 2 weeks, and reached a peak within 2-6 weeks, with the clinical effect being maintained for approximately 6-8 months, or even longer. Depending on the dose, a number of patients developed high residual volume and clean intermittent self/helper catheterization (CIC) may become necessary. Only a few side effects were described, and intravesical onabotulinum toxin A injection seems to be well tolerated. However, details on injection technique, dose interval between injections, etc. are still under debate and only a few randomized, placebo controlled studies have been published.

No abstract