Patients’ perspective of botulinum toxin‐A as a long‐term treatment option for neurogenic detrusor overactivity secondary to spinal cord injury

Abstract

OBJECTIVE To evaluate patients’ perspective on whether they would consider botulinum toxin‐A (BTX‐A) injections as a long‐term treatment option for managing their neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI). PATIENTS AND METHODS In all, 72 patients with SCI and urodynamically confirmed NDO refractory to anticholinergics, who have had at least one or more injections with BTX‐A were invited to participate in a 5‐min telephone questionnaire covering various aspects of their treatment. Questions about patient satisfaction were rated on a scale from 1 to 10 (1, not satisfied; to 10, very satisfied). RESULTS Of the 72 patients surveyed, 48 (67%) were still actively undergoing repeat BTX‐A injections. The mean patient satisfaction score was 6.2. Of the 48 patients, 43 (90%) replied that they would consider continuing with BTX‐A injections as a long‐term treatment option. Only seven (15%) of patients still having BTX‐A injections would consider an alternative permanent surgical option in the next 5 years. Of those patients considering a one‐off permanent surgical solution, younger patients were likely to consider this at a later interval than those in an older group (Spearman’s correlation coefficient, −0.52, 95% confidence interval −0.78 to −0.10, P = 0.02). The annual new patient recruitment rate was high (mean 14.4) and the annual withdrawal rate was low (mean 4.8). CONCLUSION With high satisfaction and low annual withdrawal rates, there are increasingly many patients on BTX‐A. Most consider continuing BTX‐A injections in the long term, increasing the future demand for this service. There is an urgent need for further research into optimizing the current delivery of an intradetrusor BTX‐A injection service for patients with NDO.

The effectiveness of intravesical Botox in idiopathic and non-idiopathic detrusor over activity

“…Nevertheless, when the dryness rate is compared between the two groups of patients (IDO and NDO) (Figure 1), it would need one extra patient to become dry to induce a p value of less than 0.05 and make the result statistically significant. The incidence of UTIs in IDO patients is comparable to the published literature, 19 but the NDO group showed less UTIs than the IDO group. 4.7% in NDO group compared to 6.06% in IDO group.…”

“…However, statistically it is still significant and comparable as the previous studies were based on less number of patients. 16,19 In addition, to keep consistency with our procedure and avoid mistakes we only included patients from the same centre and who had their treatments given by the same two surgeons. This has resulted in an unequal number, but, we have fewer variables for the results.…”

“…Fourteen patients went onto have further urological procedures undertaken. Of which 8 were from the nonresponder group 19 and 4 were from the responder group 20 .…”

Use of botulinum toxin in individuals with neurogenic detrusor overactivity: State of the art review

“…In addition to significant clinical and urodynamic improvements, this study showed that a sustained QoL could be achieved by repeated detrusor BoNT/A injections over a 6-year period. 44 Hori et al 62 evaluated patients' perspective of BoNT/A (Dysport ® (abobotulinumtoxinA) 750 U and 1000 U) in 72 individuals with SCI who had urodynamically confirmed NDO and poor results with anticholinergic medications. Patients who had had one or more injections with BoNT/A were invited to participate in a 5-minute telephone questionnaire and rated their satisfaction on a scale of 1-10, with 10 being "very satisfied".…”

“…This occurred in patients receiving intradetrusor injections of Dysport ® (abotulinumtoxinA) 1000 U doses, but none when the dose was reduced to 750 U. 62 Grosse et al reported that four patients had transient weakness in the trunk and/or lower extremities, all after Dysport ® injections. 39 In one of them the weakness lasted for 2 months after 1000 U/10 ml, for two the weakness lasted for 4 weeks after 750 U/10 ml -one of those had two previous Botox ® injections 300 U/ 15 ml without problems.…”