Six-Year Follow-Up of Intradetrusorial Injections of Botulinum Toxin Type a in Patients With Refractory Neurogenic Detrusor Overactivity: Clinical and Urodynamic Results

Giannantoni, Antonella; Serva, M. R.; Proietti, Silvia; Santaniello, F.; Costantini, Elisabetta; Mearini, Ettore; Porena, Massimo

doi:10.1016/s1569-9056(08)60563-1

Cited by 4 publications

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“…The cost of therapy was quantifi ed based on the National Health System resources used by typical patients and was used to calculate the cost-effectiveness of BTX-A compared with standard care [ 30• ]. It was concluded that intradetrusor BTX-A is an effective treatment for detrusor overactivity that is highly likely to be cost-effective in both idiopathic and neurogenic detrusor forms [ 29 ]. In a multicenter, cross-sectional, retrospective cohort study, Boy et al [ 31• ] collected data from seven German centers following 214 patients with NDO.…”

Section: Cost-effectiveness Of Intradetrusor Btx-a In Ndo Patientsmentioning

confidence: 99%

Intravesical strategies to manage the neurogenic bladder

Dinis¹,

Cruz

2008

Curr Bladder Dysfunct Rep

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Intravesical therapy with botulinum toxin type A (BTX-A) and vanilloids (capsaicin and resiniferatoxin) are actively investigated as potential treatments for lower urinary tract symptoms refractory to conventional therapy in patients with neurogenic detrusor overactivity. BTX-A cleaves soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) proteins in afferent and efferent nerve endings, impeding the fusion of synaptic vesicles with the neuronal membrane necessary for the release of neurotransmitters. Vanilloids desensitize the transient receptor potential vanilloid type 1 receptor and inactivate C-fi bers. BTX-A intradetrusor injections are extremely effective for treating urinary incontinence, provide adequate protection of the upper urinary tract, and improve quality of life in patients with neurogenic detrusor overactivity. Therefore, BTX-A is currently the mainstay of intravesical therapy. However, despite promising results overall, the administration of these compounds, including BTX-A, remains an experimental procedure requiring further clinical studies.

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Section: Cost-effectiveness Of Intradetrusor Btx-a In Ndo Patientsmentioning

confidence: 99%

Intravesical strategies to manage the neurogenic bladder

Dinis¹,

Cruz

2008

Curr Bladder Dysfunct Rep

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

et al. 2009

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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.

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Long‐term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction

2009

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OBJECTIVE To evaluate the influence of repeated botulinum neurotoxin A (BoNT‐A) treatments on detrusor function in patients with neurogenic detrusor overactivity (DOA) due to spinal cord lesions. PATIENTS AND METHODS In a retrospective study, urodynamic evaluations of 27 consecutive patients with neurogenic DOA due to spinal cord lesions who received at least five BoNT‐A treatments were analysed. RESULTS After the first BoNT‐A treatment, bladder capacity, reflex volume, continence status and detrusor compliance were significantly improved and maximum detrusor pressure (Pdetmax) was significantly reduced. The mean number of BoNT‐A treatments was 7.1. Compared with the results of the first treatment, the incontinence rate (seven patients) and the number of patients with an elevated Pdetmax (five patients) were slightly increased after the final BoNT‐A treatment. The long‐term success rate was 74%. Every fourth patient needed a major surgical intervention. There was a significant decrease in Pdetmax before BoNT‐A treatments, indicating that detrusor contraction strength did not completely recover after treatment. CONCLUSIONS Our study confirmed the long‐term efficacy of repeated BoNT‐A treatments in patients with neurogenic DOA. However, in long‐term follow‐up, every fourth patient required surgical interventions. Moreover, our data give the first hint that BoNT‐A may lead to impaired detrusor contraction strength, which could influence future treatment options. Prospective studies are necessary to elucidate the impact of repeated BoNT‐A treatments on detrusor function and the interactions with future treatment options.

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Six-Year Follow-Up of Intradetrusorial Injections of Botulinum Toxin Type a in Patients With Refractory Neurogenic Detrusor Overactivity: Clinical and Urodynamic Results

Cited by 4 publications

References 0 publications

Intravesical strategies to manage the neurogenic bladder

Intravesical strategies to manage the neurogenic bladder

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

Long‐term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction

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