Onabotulinumtoxina Intravesical Treatment in Patients Affected by Overactive Bladder Syndrome: Best Practice in Real-Life Management

Abstract

Purpose:We evaluated intradetrusorial OnabotulinumtoxinA (Onabot/A) treatment protocols in patients with idiopathic overactive bladder (OAB), in order to assess the care of patients before, during and after treatment. Methods: In 64 OAB patients injected with Onabot/A, we reviewed the length of the hospital stay, frequency of catheterization, frequency of intraoperative and postoperative complications, and patients' satisfaction to the proposed treatment protocol (as assessed by VAS). We also compared the results of the 3-day voiding diary, uroflowmetry with postvoid residual urine (PVR) and VAS to score the bother of urinary symptoms on quality of life (QoL) before and after treatment. Results: Twenty-one patients were firstly treated in an 'inpatient' setting. The mean ± SD duration of hospitalization and catheterization was 39.4 ±12.6 and 37.8 ± 10.6 h, respectively. The mean ± SD VAS values of treatment satisfaction and of bother of urinary symptoms on QoL were 6.3 ± 1.1 and 8.2 ± 1.3, respectively. The mean ± SD PVR value was 74.3 ± 15.2 ml. Frequency of UTIs was 2.4 ± 1.6. Forty-three patients were treated on an outpatient basis; the mean ± SD duration of catheterization, the 'outpatient' stay and the mean ± SD frequency of UTIs were lower than those of patients treated in an inpatient setting. The mean ± SD VAS value to score QoL was high. Conclusions: Intradetrusorial Onabot/A injection is a simple and fast procedure that can be easily carried on in an outpatient setting under local anesthesia, with low rates of intraoperative and postoperative complications.

Onabotulinumtoxin-A improves health status and urinary symptoms in subjects with refractory overactive bladder: Real-life experience

“…We chose a daysurgery protocol because it affords greater safety to clinicians if complications arise that require management; however, other authors reported successfully applying treatment in outpatient settings. 28 Despite reports in the literature of a non-negligible discontinuation rate (between 10% and 30%), 29 none of the patients in our series abandoned the study. In other papers, the most commonly cited reasons for discontinuing treatment were lack of efficacy or dislike of CIC; 30 however, we did not record any occurrences of inability to perform CIC or of pain on injection.…”

“…We chose a day-surgery protocol because it affords greater safety to clinicians if complications arise that require management; however, other authors reported successfully applying treatment in outpatient settings. 28…”

Treatment of idiopathic overactive bladder with botulinum toxin: real-life results and patients’ expectations

“…The mean age at first injection was 60.7 ± 15.3 years . Globally, 268 treatments were performed and the mean number of injections per patient was 1.96 ± 1.32 (1)(2)(3)(4)(5)(6)(7)(8).…”

“…Although urgency UI may suggest detrusor overactivity, it is not necessary to urodynami-cally demonstrate involuntary contractions of the muscle 5 . OAB is coined as idiopathic (iOAB) when a specific metabolic or pathologic condition that can be the cause is not identified 3 …”

Neuronal Activation in the Periaqueductal Gray Matter Upon Electrical Stimulation of the Bladder

“…Nowadays, the first line treatment for OABS relies on the application of antimuscarinic drugs (Madhuvrata et al, 2012 ; Veenboer and Bosch, 2014 ). The second line therapies include botulinum toxin injection into the detrusor muscle (Chapple et al, 2013 ; Nitti et al, 2013 ; Mangera et al, 2014 ; Giannantoni et al, 2015 ), sacral neuromodulation (Peters et al, 2009 , 2010 ; Sukhu et al, 2016 ) or invasive surgical interventions such as an augmentation cystoplasty (Reyblat and Ginsberg, 2008 ). However, these therapeutic interventions are only effective in a subset of patients and their effectiveness is limited in the remainder.…”