Experience with different botulinum toxins for the treatment of refractory neurogenic detrusor overactivity

Gomes, Cristiano Mendes; Filho, Jose Everton de Castro; Rejowski, Ronald F.; Trigo-Rocha, Flavio; Bruschini, Homero; Filho, Tarcísio Eloy Pessoa de Barros; Srougi, Miguel

doi:10.1590/s1677-55382010000100011

Cited by 13 publications

(6 citation statements)

References 20 publications

(17 reference statements)

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“…Gomes et al compared the use of two different BTX-A formulations (Botox® and Prosigne®). Botox treatment resulted in significantly greater increase of urodynamics parameters, and a tendency for better results in terms of continence rate (13).…”

Section: Introductionmentioning

confidence: 93%

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

et al. 2011

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Purpose: Neurogenic detrusor overactivity (NDO) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A) injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS. Materials and Methods: Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor), improvement, or total failure (urge incontinence and overactive detrusor). Results: 77% of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001), maximum cystometric capacity (p = 0.0035), maximum detrusor pressure (p = 0.0000001). 46% of the patients were in the "full success" group. 31% of the patients had a partial improvement. 23% of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015). Conclusions: Despite that a full success was obtained in 46% of the cases, BTX-A injection therapy failed to treat refractory NDO in 23% of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anticholinergic drugs fail to reduce NDO. Multiple sclerosis (MS) is a common demyelinating disease of the central nervous system. The lesions occur in different time and localization in subcortical areas, brain stem and spinal cord. The disease has varied clinical presentations (1). Bladder and urethra dysfunction are very common. Detrusor overactivity is the most common urodynamic sign. It is observed in 44% (2) to 81% (3) of patients. Detrusor sphincter dyssynergia is associated with overactive detrusor in 93% of cases (2).Detrusor overactivity is often associated with overactive bladder, defined by urgency, possibly associated with urge incontinence, daytime frequency, and nocturia (4). These symptoms significantly alter the quality of life (5). Urological complications including hydronephrosis, vesicoureteral reflux, urosepsis, and urolithiasis (6) occur in 12% of the patients who suffer from neurogenic detrusor overactivity (NDO) and MS (7). The rate NeurourologyInternational Braz J Urol

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Section: Introductionmentioning

confidence: 93%

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

et al. 2011

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“…Other BoNT/A such as NT-201 (Xeomin®) or CBTX-A distributed under several different brand names in different countries (Prosigne®, Lanzox®, Lantox®, Liftox®, and Redux®) have been studied by some authors, but evidence in literature is still lower compared to the Abo and OnaBoNT/A ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Long-term response of different Botulinum toxins in refractory neurogenic detrusor overactivity due to spinal cord injury

et al. 2017

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Purpose To assess the response in spinal cord injured patients alternatively treated with different types and dosages of Botulinum neurotoxin type A (BoNT/A) over 15 years.Material and methods Patients who underwent first BoNT/A from 1999-2001 and practiced intermittent catheterization were included. Baseline 3-day bladder diary (BD) and urodynamics were collected. BoNT/A failure was defined when patients asked for re-injection ≤ 3 months post-treatment. Criteria for re-injection was at least one daily episode of urinary incontinence at BD. Before re-injection, patients were asked if they had reached 6 months of dryness without antimuscarinics (YES response).Results Overall, 32/60 (53.4%) “No failure” (NF) group; 16 (26.6%) “occasional failure” (OF) and 12 (20%) “consecutive failure” (CF) were included. A total of 822 BoNT/A infiltrations were performed. The mean interval from previous injection to treatment re-scheduling was 8 months. No significant differences between treatments were found within the three groups (p>0.05). The percentage of YES responses increased from 19% (AboBoNT/A 500IU) to 29 % (OnaBoNT/A 300IU) in NF, and from 18% (AboBoNT/A 500IU) to 25% (OnaBoNT/A 300IU) for OF. Five NF cases (15.6%) maintained 6 months of dryness after each injection. Among the baseline variables, only low compliance (< 20mL/cmH2O) was found as predictor for failure (p=0.006).Conclusions Long term BoNT/A for NDO did not increase failures, independent of the types of treatments and switching. Definition of failure and other criteria for continuing repetitive BoNT/A treatment is mandatory. CF was predictable for no response in earlier follow-up.

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“…We note that some of these patients did not reduce the dose because they were afraid that the urinary losses would return after being continent. According to previous studies, some factors that may be related to the efficacy of BTX-A injections into the detrusor muscle include, for example, whether the doses of anticholinergics used before the procedure were considered high (refractory bladder) [7], what the optimal dose of BTX-A is [11,12], the formulations used [13,14] and the injection technique [11]. These factors may explain some of the differences observed in the results across different studies.…”

Section: Discussionmentioning

confidence: 99%

A pilot prospective study to evaluate whether the bladder morphology in cystography and/or urodynamic may help predict the response to botulinum toxin a injection in neurogenic bladder refractory to anticholinergics

2014

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BackgroundWe have observed different clinical responses to botulinum toxin A (BTX-A) in patients who had similar urodynamic parameters before the procedure. Furthermore, some bladders evaluated by cystography and cystoscopy during the procedure had different characteristics that could influence the outcome of the treatment. The aim of this study was to assess whether cystography and urodynamic parameters could help predict which patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergics respond better to treatment with injection of BTX-A.MethodsIn total, 34 patients with spinal cord injury were prospectively evaluated. All patients emptied their bladder by clean intermittent catheterization (CIC) and had incontinence and NDO, despite using 40 mg or more of intravesical oxybutynin and undergoing detrusor injection of BTX-A (300 IU). Pretreatment evaluation included urodynamic, and cystography. Follow-up consisted of urodynamic and ambulatory visits four months after treatment. The cystography parameters used were bladder shape, capacity and presence of diverticula. Urodynamic parameters used for assessment were maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), compliance and reflex volume (RV).ResultsAfter injection of BTX-A, 70% of the patients had success, with 4 months or more of continence. Before the treatment, there were significant differences in most urodynamic parameters between those who responded successfully compared to those who did not. Patients who responded successfully had greater MCC (p = 0.019), higher RV (p = 0.041), and greater compliance (p = 0.043). There was no significant difference in the MDP (0.691). The cystography parameters were not significantly different between these groups bladder shape (p = 0.271), capacity (p > 0.720) and presence of diverticula (p > 0.999). Statistical analyses were performed using SPSS (version 20.0) and included Student’s t-test for two paired samples and Fisher’s exact test, with a significance threshold of 0.05.ConclusionsThis study suggests that the cystography parameters evaluated cannot be used to help predict the response to injection of BTX-A in the treatment of refractory NDO. However, the urodynamic parameters were significantly different in patients who responded to the treatment, with the exception of the MDP.

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Experience with different botulinum toxins for the treatment of refractory neurogenic detrusor overactivity

Cited by 13 publications

References 20 publications

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

Long-term response of different Botulinum toxins in refractory neurogenic detrusor overactivity due to spinal cord injury

A pilot prospective study to evaluate whether the bladder morphology in cystography and/or urodynamic may help predict the response to botulinum toxin a injection in neurogenic bladder refractory to anticholinergics

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