Management of Idiopathic Overactive Bladder Syndrome: What Is the Optimal Strategy After Failure of Conservative Treatment?

Marcelissen, Tom; Cornu, Jean‐Nicolas; Antunes-Lopes, Tiago; Geavlete, Bogdan; Delongchamps, Nicolas Barry; Rashid, Tina; Rieken, Malte; Rahnama’i, Mohammad Sajjad

doi:10.1016/j.euf.2018.05.004

Cited by 31 publications

(35 citation statements)

References 51 publications

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“…After initial failure or intolerance to these conservative measures, three more invasive options can be proposed to the patient, posterior tibial nerve stimulation, sacral neuromodulation (SNM), or intradetrusor botulinum toxin A (BoNT‐A) injections 3 . Some studies have tried to identify the best strategy for treating patients with iOAB after the initial failure of conservative therapy 4,5 . As all three treatments appear to have similar efficacy, selection between treatments is currently based on physician's experience and patient's preference 5 .…”

Section: Introductionmentioning

confidence: 99%

“…4,5 As all three treatments appear to have similar efficacy, selection between treatments is currently based on physician's experience and patient's preference. 5 However, the management of patients who failed SNM or BoNT-A injections remains challenging. Although, in that case, Marcelissen et al 5 recommend to switch to another third-line treatment, literature on the subject is scarce.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Baron

Perrouin-Verbe

Lacombe³

et al. 2020

Neurourology and Urodynamics

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Introduction Management of idiopathic overactive bladder (iOAB) after the failure of sacral nerve modulation (SNM) is very challenging. To the best of our knowledge, no study has evaluated the use of botulinum toxin A (BoNT‐A) after SNM failure for iOAB. The aim of this study is to evaluate the tolerance and efficacy of BoNT‐A injection after the failure of SNM for iOAB. Methods We conducted a retrospective multicentric analysis of all patients who had received either onabotulinumtoxinA or abobotulinumtoxinA intradetrusor injection for iOAB after SNM failure, between January 2004 and December 2017. The primary outcome was the percentage of success of first BoNT‐A injection (either resolution of their urinary incontinence or their frequency or more than 50% reduction in frequency). Secondary outcomes were results of urodynamic studies, complications, total number of injections, causes of withdrawal, and subsequent treatment. Results Seventy‐six patients (62 female) were included. The percentage of success of first BoNT‐A injection was 43.4% (n = 33). All overactive bladder symptoms were significantly improved on the 3‐day bladder diary. Twenty‐eight patients (36.8%) were put under clean intermittent self‐catheterization transitory. After a mean follow‐up of 57.7 (±38.5) months, median number of injections was 2 (1‐15). Overall, 42 patients (55.2%) stopped injections during follow‐up. The estimated 36‐months discontinuation‐free rate was 48.1%. Mean cause of discontinuation was a primary failure (n = 32; 42.1%). Conclusion BoNT‐A can be used in SNM nonresponders with a success rate of 43.4% but is associated with a high long‐term discontinuation rate.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Baron

Perrouin-Verbe

Lacombe³

et al. 2020

Neurourology and Urodynamics

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“…Neurologic diseases [e.g., cerebrovascular accident [CVA], neuro-degenerative disease, multiple sclerosis [MS], brain and spinal cord traumatic injury and others] are often associated with LUTS [6] .…”

Section: Introductionmentioning

confidence: 99%

Lower urinary tract symptoms related to neurological diseases in Egyptian patients

Aboelsaad

Mohamed

Hindawy

2019

International Journal of Medical Arts

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Background: Lower urinary tract symptoms [LUTS] have a marked impact on the quality of life in patients with neurological ailments. They are also linked to a high risk of serious morbidities. Aim of the work: was to evaluate the LUTS associated with neurological disorders in a sample of Egyptian patients. Patients and Methods: This study conducted on 104 patients treated in our Neurology and urology clinic at Al-Azhar University hospitals from January 2018 to January 2019. Patients divided into several subgroups according to the neurological diagnosis, and the following data were collected: age, sex, irritative symptoms [frequency, urgency, and urge incontinence], obstructive symptoms [straining, slow stream, hesitancy, retention of urine], timing [before or after neurological disease], and finally evolution of symptoms either solved or persistent. Results: We studied 104 patients; 53 were females and 51 males. LUTS were found in 44 out of 104 patients [42.3%]. LUTS were more presented in patients with neurovascular, spinal cord and demyelinating disorders. Urinary urge incontinence was the most common symptom [70.4%]. It was found to be predominant in the neurovascular and demyelinating diseases. In 30 out 44 subjects, the urinary symptoms persist, in 14 out of them the urinary problems were treated. Conclusions: Storage symptoms are more common, mostly urge urinary incontinence. Neurovascular diseases, spinal cord, and demyelinating diseases are the most common neurological disorders associated with LUTS. A multidisciplinary method should be encouraged for the management of these patients including the whole team of rehabilitation.

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“…Unfortunately, most patients eventually discontinue therapy with antimuscarinics and beta‐3 agonists due to dissatisfaction with treatment response or intolerance of side effects . In patients whose symptoms are refractory to oral therapy, several third‐line treatment options may be considered including botulinum toxin A (BTA) injections, sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS), all of which provide therapeutic benefit . However, each of these treatments are associated with distinct limitations.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 In patients whose symptoms are refractory to oral therapy, several third-line treatment options may be considered including botulinum toxin A (BTA) injections, sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS), all of which provide therapeutic benefit. 10 However, each of these treatments are associated with distinct limitations. BTA injections provide symptomatic relief for about 6 months, but side effects include urinary tract infection and urinary retention requiring catheterization.…”

Section: Introductionmentioning

confidence: 99%

Initial clinical experience with selective bladder denervation for refractory overactive bladder

Wachter

Robert

et al. 2018

Neurourology and Urodynamics

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Aims To report the initial clinical experience with selective bladder denervation (SBD) of the trigone in women with refractory overactive bladder (OAB). Methods Females with refractory OAB underwent SBD of the bladder sub‐trigone region. Patients were treated using a 10‐s voltage‐controlled radiofrequency (RF) algorithm (RF10) at study onset. The protocol was modified during the study after which point remaining patients received 60‐s temperature‐controlled RF (RF60). Patients were followed for 12 weeks and evaluated for adverse events and changes in OAB symptoms. Exploratory analyses on the influence of RF duration were performed. Results Among 63 patients, SBD resulted in statistically significant and clinically important improvements for most outcomes. Comparing RF10 (n = 34) to RF60 (n = 29), treatment benefit was greater with RF60 including mean reduction in urgency urinary incontinence (−2.5 vs −0.9; P < 0.01), urinary incontinence (−2.6 vs −0.8; P < 0.001), and total urgency and frequency score (−13 vs −7; P = 0.02); and improvements in symptom bother (−33 vs −18; P < 0.01) and quality of life (28 vs 16; P = 0.02) on the OAB questionnaire. The proportion of urgency urinary incontinence treatment responders (≥50% reduction in episodes) was 79% with RF60 and 31% with RF10. The frequency of device‐ or procedure‐related adverse events was comparable in RF10 versus RF60 groups (14.7% vs 17.2%). Conclusions This study demonstrated the feasibility of SBD in alleviating symptoms of refractory OAB. A 60‐s RF algorithm using deeper ablations of the sub‐trigonal tissues was more effective and comparably safe to a 10‐s RF algorithm using more superficial ablations.

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Management of Idiopathic Overactive Bladder Syndrome: What Is the Optimal Strategy After Failure of Conservative Treatment?

Cited by 31 publications

References 51 publications

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder

Lower urinary tract symptoms related to neurological diseases in Egyptian patients

Initial clinical experience with selective bladder denervation for refractory overactive bladder

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