Botulinum A toxin as a treatment for overactive rectum with associated faecal incontinence

Bridoux, Valérie; Gourcerol, Guillaume; Kianifard, B.; Touchais, J. Y.; Ducrotté, Philippe; Leroi, A.-M.; Michot, F; Tuech, J.‐J.

doi:10.1111/j.1463-1318.2011.02585.x

Cited by 21 publications

(14 citation statements)

References 28 publications

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“…A single report of onabotulinumtoxinA (200-400 U) use in an Indiana pouch (neobladder from ascending colon and distal ileum) following cystectomy, resulting in incontinence control over 3 years is documented 19 Positive results have also been reported for rectal overactivity/fecal incontinence. 20 These studies and those in augmented bladders above remains unique in the context of intra-augment injections. The current market license for BOTOX is limited to injections in the detrusor muscle, and not into bowel.…”

Section: Discussionmentioning

confidence: 98%

The efficacy of onabotulinumtoxinA in patients with previous failed augmentation cystoplasty: Cohort series and literature review

Toia

Pakzad

Hamid

et al. 2020

Neurourology and Urodynamics

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Aims To investigate the role of onabotulinumtoxinA (BTX‐A) injections in patients with failed augmentation cystoplasty for neuropathic or idiopathic detrusor overactivity (NDO or IDO). Methods A retrospective review of all cystoplasty patients who underwent onabotulinumtoxinA injection at a tertiary center between 2008 and 2019 was performed. Details including indications and time from cystoplasty, video‐urodynamic parameters, onabotulinumtoxinA dose, and clinical outcomes were analyzed. Telephone interview was performed for patients that requested repeat onabotulinumtoxinA injections. The interview included a modified PGIC7 and UDI6 questionnaires. A positive clinical response was considered improvement of overactive symptoms sufficient to merit repeat onabotulinumtoxinA injection and a modified PGIC7 of four or above. Results Thirty patients were identified (11 men and 19 women). The indications for augmentation were IDO (n = 18) or NDO (n = 12). Mean age at the time of cystoplasty was 42 years (range, 10‐61). Interval between cystoplasty and initial onabotulinumtoxinA was 98 months (range, 3‐271). Video‐urodynamics before onabotulinumtoxinA revealed low compliance in 13 patients, DO in 22 patients, and combined low compliance/DO in 10. The median maximum cystometric bladder capacity was 338 mL (range, 77‐570 mL). Thirteen patients responded to onabotulinumtoxinA injections. Higher peak DO pressure was associated with a significantly higher chance that the patient would experience benefit from the injections P = .026). The patients that responded to onabotulinumtoxin A underwent a total of 115 procedures (mean, 8.8 injections) over a mean 88 months (range, 20‐157 months). Conclusions Forty‐three percent of patients responded well to intra‐detrusor onabotulinumtoxinA injections. This avoided the need for more invasive surgery and had a positive impact on their quality of life.

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Section: Discussionmentioning

confidence: 98%

The efficacy of onabotulinumtoxinA in patients with previous failed augmentation cystoplasty: Cohort series and literature review

Toia

Pakzad

Hamid

et al. 2020

Neurourology and Urodynamics

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“…23 However, the risk of bowel impairment seems to be multifactorial and may include other confounding factors such as reduced rectal reservoir, diminished mobility at the level of the rectal scar, stenosis of rectal anastomosis, 24 and decrease in the ability to attenuate the transmission of high intracolonic pressure toward the anal sphincter. 25,26 The prevalence of postoperative constipation is high in patients managed by colorectal resection and report lesser satisfactory gastrointestinal scores when compared with those treated by rectal shaving. 27 However, in patients managed by rectal shaving or disc excision, preoperative constipation scores are not significantly improved by the surgery itself.…”

Section: Nerve Sparing In Endometriosis: Pessimism Of the Intellect Omentioning

confidence: 99%

Nerve Sparing and Surgery for Deep Infiltrating Endometriosis: Pessimism of the Intellect or Optimism of the Will

Darwish

Roman

2016

Semin Reprod Med

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Nerve-sparing surgery is an emerging technique for surgery-related dysfunction. Within the past 15 years, an essential progress in recognition and understanding of the anatomy of the pelvic autonomous nervous system has been made. Surgical preservation of vegetative nerves has become well known in many cancer centers. The technique has led to improvement of the quality of life following oncologic radical procedures. Positive results have led to the adoption of such techniques in the surgical treatment of deep infiltrating endometriosis in an aim to prevent urinary, rectal, and sexual dysfunction. Even though nerve-sparing excision of endometriosis is feasible and offers good outcomes in terms of bladder morbidity; digestive and sexual functions seem to be more complex to assess. Moreover, functional impairment in deep infiltrating endometriosis may preexist prior to surgery and function may not be restored despite nerve preservation. In cases where endometriosis lesions are deeply embedded in the parametrium, nerve-sparing techniques may only be feasible in those with a unilateral involvement. The nerve-sparing surgical approach is therefore a safer radical surgery in the hands of experienced surgeons that has to be tailored to the unique nature of deep infiltrating endometriosis and balanced between the natural aggressiveness of such a debilitating disease and postoperative morbidity. Good knowledge of pelvic nerve anatomy and function allows understanding of related symptoms to reduce morbidity, whenever this goal is still achievable.

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“…Exclusion criteria were pregnancy, breastfeeding, psychiatric disorders, myasthenia gravis, polyradiculoneuropathy, history of inhalation pneumopathy, full-thickness rectal prolapse, extensive anal sphincter lesions, fecal impaction, and anorectal pathologies such as inflammatory bowel disease and cancer. The selected subjects were added to those from our previous study [6]. Patients provided written, informed consent for the endoscopic BTX-A injections.…”

Section: Patientsmentioning

confidence: 99%

“…Based on the experience of urologists treating overactive bladder, we hypothesized that BTX-A rectal/reservoir in-jections might inhibit spontaneous rectal/reservoir contractions and, at the same time, increase rectal/reservoir capacity and compliance, providing fecal incontinence relief for patients, with or without a hypercontractile rectum/reservoir. In a preliminary study, we demonstrated that the short-term results of six patients with severe fecal incontinence related to hypercontractile rectum or colonic pouch following proctectomy who received reservoir BTX-A injections were encouraging [6]. The aim of the present study was to assess the short-term clinical outcomes of a larger sample of patients with various etiologies underlying their fecal incontinence, whether or not they had rectal/reservoir contractile activity, following BTX-A injections.…”

mentioning

confidence: 90%

Botulinum toxin: an endoscopic approach for treating fecal incontinence

et al. 2015

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Botulinum A toxin as a treatment for overactive rectum with associated faecal incontinence

Abstract: Patients with an 'overactive rectum' are a heterogeneous group, with varying causes of dysfunction. The dose of BT used was arbitrarily selected. Nevertheless, the study introduces a further therapeutic option in the treatment of FI caused by rectal overactivity.

Cited by 21 publications

References 28 publications

The efficacy of onabotulinumtoxinA in patients with previous failed augmentation cystoplasty: Cohort series and literature review

The efficacy of onabotulinumtoxinA in patients with previous failed augmentation cystoplasty: Cohort series and literature review

Nerve Sparing and Surgery for Deep Infiltrating Endometriosis: Pessimism of the Intellect or Optimism of the Will

Botulinum toxin: an endoscopic approach for treating fecal incontinence

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