Botulinum toxin treatment for overactive bladder: Risk of urinary retention

Shaban, Ahmed; Drake, Marcus

doi:10.1007/s11934-008-0077-1

Cited by 24 publications

(10 citation statements)

References 31 publications

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“…In contrast, the placebo group of this series showed no increase of residual urine. Overall, the risk of developing significant residual urine or acute urinary retention seems to increase with higher doses of injected botulinum toxin [19] . In addition, patients with neurogenic OAB suffer more often from urinary retention after botulinum A injections into the bladder [17] .…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Side Effects of Intradetrusor Botulinum Toxin Type A for Idiopathic Overactive Bladder Syndrome

et al. 2010

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Objective: The aim of the study was a prospective assessment of patient-reported side effects in an open-label study after intradetrusor botulinum toxin injections for idiopathic overactive bladder (OAB). Patients and Methods: Botulinum toxin A injection was performed in 56 patients with idiopathic OAB. Patients were followed up for 6 months concerning side effects and patients’ satisfaction. Results: Different types of side effects were assessed such as dry mouth (19.6%), arm weakness (8.9%), eyelid weakness (8.9%), leg weakness (7.1%), torso weakness (5.4%), impaired vision (5.4%) and dysphagia (5.4%). In all cases, symptoms were mild and transient. Urological complications such as gross hematuria (17.9%), acute urinary retention (8.9%) and acute urinary tract infection (7.1%) were noticed. In all cases, acute urinary retention was transient and treated with temporary intermittent self-catheterization. There was no statistically significant correlation between dosage and observed side effects. Patients’ satisfaction rate was high (71.4%). Conclusion: Intradetrusor injection of botulinum toxin was associated with a high rate of neurourological side effects. In general, side effects were transient, mild and did not require special treatment.

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Section: Discussionmentioning

confidence: 99%

Patient-Reported Side Effects of Intradetrusor Botulinum Toxin Type A for Idiopathic Overactive Bladder Syndrome

et al. 2010

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“…Overall rates of urinary retention or necessity of intermittent catheterization after intravesical injection of botulinum toxin for all indications are relatively poorly reported and may depend on the dose injected and the location of the injection. 16 Urinary retention after intravesical injections of botulinum toxin for IDO has been reported in approximately 5% of cases. 1 Although we noted a statistically significant increase in PVRs from baseline to the 3-month followup period, it was not clinically important.…”

Section: Discussionmentioning

confidence: 99%

Botulinum A Toxin/Dimethyl Sulfoxide Bladder Instillations for Women With Refractory Idiopathic Detrusor Overactivity: A Phase 1/2 Study

Petrou

Parker

Crook

et al. 2009

Mayo Clinic Proceedings

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We completed a phase 1/2 trial to evaluate the safety and potential efficacy of direct intravesical instillation of a botulinum type A toxin/dimethyl sulfoxide (DMSO) solution for treatment of idiopathic detrusor overactivity in women. Twenty-five women with medication-resistant, urodynamic-confirmed idiopathic detrusor overactivity were enrolled. A total of 9 patients were treated in phase 1 of the study. Three patients were given a 66% dosing of solution; 22 patients received the full 300 units of botulinum toxin and 50 mL of DMSO (50% concentration). Adverse effects, 24-hour pad weights, episodes of incontinence, postvoid residuals, and scores on the Blaivas-Groutz anti-incontinence scale, Indevus Urgency Severity Scale, Incontinence Impact Questionnaire-short form, and Urogenital Distress Inventory (6 items) questionnaire were recorded at baseline, 1 month, and 3 months after instillation. No serious adverse effects or clinically important increases in postvoid residual occurred. Among the 21 women who completed phase 2 of the study, the median number of incontinent episodes decreased from 4 at baseline to 2 at 1 month (P=.004) and increased to 4 at 3 months (P=.81). Median scores improved from baseline to 1 month on the Incontinence Impact Questionnaire (from 13 to 7; P=.007) and Urogenital Distress Inventory (from 10 to 5; P=.003). Although 11 women (52%) reported severe urgency based on the Indevus Urgency Severity Scale at baseline, only 1 (5%; P<.001) and 3 (14%; P=.004) women reported severe scores at 1 and 3 months, respectively. Direct instillation of botulinum toxin/DMSO solution is safe. Its promising clinical effect warrants further evaluation in a randomized, placebo-controlled phase 3 setting.

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“…[4142] Intravesical botulinum toxin injections, an unlicensed procedure for management of OAB,[43] also carry a significant risk of UR, which appears to increase with repetition of injections following return of symptoms. [44] Risk factors for UR and regimes achieving optimal balance of sustained efficacy with minimized adverse effects are still uncertain; patients should be aware of the risk accordingly, and should be willing to accept the possibility of needing IC subsequently.…”

Section: Iatrogenic Boo Related To Surgery For Treatment Of Urinary Imentioning

confidence: 99%

Etiology and management of urinary retention in women

Mevcha

Drake

2010

Indian J Urol

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Urinary retention (UR) can be defined as inability to achieve complete bladder emptying by voluntary micturition, and categorized as acute UR, chronic UR or incomplete bladder emptying. UR is common in elderly men but symptomatic UR is unusual in women. The epidemiology of female UR is not well documented. There are numerous causes now recognized in women, broadly categorized as infective, pharmacological, neurological, anatomical, myopathic and functional; labeling symptoms as having a “psychogenic basis” should be avoided. Detrusor failure is often an underlying factor that complicates interpretation. Initial management includes bladder drainage (intermittent or indwelling catheterization) if the woman is symptomatic or at risk of complications, and correcting likely causes. Investigations should be focused on identifying the underlying etiology and any reversible factor. A detailed history, general and pelvic examination are needed; urine dipstick analysis, routine microscopy and culture, and pelvic and renal ultrasound are suitable baseline investigations. Urodynamic tests are required in specific situations. Urethral dilatation has a limited role, but it should be considered if there is urethral stenosis. Definitive management requires correction of cause where possible and symptom management where no correctable cause is detected. Follow-up is needed for monitoring response to treatment, detection of complications and symptom control. Fowler’s syndrome is a specific group diagnosed on urethral sphincter electromyogram, representing a very challenging clinical scenario.

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Botulinum toxin treatment for overactive bladder: Risk of urinary retention

Cited by 24 publications

References 31 publications

Patient-Reported Side Effects of Intradetrusor Botulinum Toxin Type A for Idiopathic Overactive Bladder Syndrome

Patient-Reported Side Effects of Intradetrusor Botulinum Toxin Type A for Idiopathic Overactive Bladder Syndrome

Botulinum A Toxin/Dimethyl Sulfoxide Bladder Instillations for Women With Refractory Idiopathic Detrusor Overactivity: A Phase 1/2 Study

Etiology and management of urinary retention in women

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