Efficacy and Safety of Intravesical OnabotulinumtoxinA Injection on Elderly Patients with Chronic Central Nervous System Lesions and Overactive Bladder

Abstract

PurposeIntravesical injection of onabotulinumtoxinA is an effective treatment for overactive bladder (OAB). Nonetheless, the treatment outcome is unclear in OAB patients with central nervous system (CNS) lesions. This study evaluated the efficacy and safety of intravesical onabotulinumtoxinA treatment in elderly patients with chronic cerebrovascular accidents (CVAs), Parkinson’s disease (PD) and dementia.Materials and MethodsPatients with CVA, PD, dementia, and OAB refractory to antimuscarinic therapy were consecutively enrolled in the study group. Age-matched OAB patients without CNS lesions were selected to serve as a control group. OnabotulinumtoxinA (100 U) was injected into the bladder suburothelium at 20 sites. The clinical effects, adverse events, and urodynamic parameters were assessed at baseline and 3 months post-treatment. The Kaplan-Meier method was used to compare long-term success rates between groups.ResultsA total of 40 patients with OAB due to CVA (23), PD (9), dementia (8) and 160 control patients were included in this retrospetive analysis. Improvement of urgency severity scale, increased bladder capacity and increased post-void residual volume were comparable between the groups at 3 months. Patients with CNS lesions did not experience increased risks of acute urinary retention and urinary tract infection; nonetheless, patients with CVA experienced a higher rate of straining to void. Long-term success rates did not differ between the patients with and without CNS lesions.ConclusionIntravesical injection of 100 U of onabotulinumtoxinA effectively decreased urgency symptoms in elderly OAB patients with CNS lesions. The adverse events were acceptable, and long-term effects were comparable to OAB patients in general. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization need careful evaluation for this very vulnerable population before choosing intravesical onabotulinumtoxinA treatment.

Management of LUTS in patients with dementia and associated disorders

“…Concerning the surgical treatment of refractory urgency urinary incontinence, there is also a lack of high‐quality studies. Jiang et al retrospectively evaluated efficacy and safety of intravesical onabotulinum toxin A injection in 40 elderly patients with chronic central nervous system lesions and overactive bladder, including cerebral vascular accidents, Parkinson disease, and dementia, versus 160 controls. Improvement of urgency severity scale, increased bladder capacity, and increased post‐void residual volume were comparable between the groups at 3 months.…”

“…Once there are no clinical trials to evaluate different surgical strategies for refractory urinary incontinence in dementia patients and considering the higher reported rates of perioperative complications in these patients, surgical approaches are usually reserved for individuals with good general status and ambulation …”

Current and potential urological applications of botulinum toxin A

“…100 In an evaluation of the efficacy and safety of 100unit intravesical injections of BoNTA in elderly patients with chronic cerebrovascular accident, Parkinson disease or dementia, intravesical injections of BoNTA effectively decreased urgency symptoms in elderly patients with OAB and CNS lesions. 101 The adverse events profile was acceptable, and longterm effects were generally comparable with those of patients with OAB who received similar treatments. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization requires careful evaluation before bladder injections of BoNTA should be consid ered a viable treatment of LUTS in this very vulnerable population of patients.…”

“…Nonetheless, the possibility of longstanding urinary retention and chronic catheterization requires careful evaluation before bladder injections of BoNTA should be consid ered a viable treatment of LUTS in this very vulnerable population of patients. 101 Paediatric LUTD BoNTA is not currently licensed for treatment of paedi atric patients with LUTD, although the indications have been expanded to treat paediatric NDO or non neurogenic OAB. 102 Detrusor injections of 5-10 units per kg spread over 30-40 sites have been reported to increase cystometric bladder capacity, decrease detru sor pressure and increase bladder compliance in paedi atric patients with myelomeningocele and NDO.…”

Disease-Specific Outcomes of Botulinum Toxin Injections for Neurogenic Detrusor Overactivity

“…1 Intravesical injection of onabotulinumtoxinA has been reported in just a few groups of such patients (Table 3). 47,48 This data indicates that onabotulinumtoxinA might be effective in these patients but the results might not be as favorable as in other settings. In addition, the possibility of urinary retention and urinary tract infection must receive serious consideration in this chronically ill and fragile group of patients.…”