Use of botulinum-A toxin for the treatment of refractory overactive bladder symptoms: an initial experience

• Published in: Urology (Ridgewood, N.J.) N.J.), 2004-06, Vol.63 (6), p.1071-1075
• Main Authors: Rapp, David E., Lucioni, Alvaro, Katz, Erin E., O'Connor, R.Corey, Gerber, Glenn S., Bales, Gregory T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Botulinum Toxins, Type A - therapeutic use; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Treatment Outcome; Urinary Bladder Diseases - complications; Urinary Bladder Diseases - drug therapy; Urinary Incontinence - drug therapy; Urinary Incontinence - etiology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2004.01.041

To define the role of botulinum toxin type A (botulinum-A) intradetrusor injections in the treatment of patients with symptoms of bladder overactivity in whom previous anticholinergic therapy has failed. Thirty-five patients (29 women and 6 men) with frequency, urgency, and/or urge incontinence received 300 U of botulinum-A toxin injected transurethrally at 30 sites within the bladder. Patients were evaluated at 3 weeks and 6 months after treatment by completion of the short forms of the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6), as well as questions assessing global response to the treatment. After 3 weeks, the mean IIQ-7 score decreased from 19.4 to 13.9 ( P = 0.0006) and the mean UDI-6 score decreased from 16.8 to 12.8 ( P = 0.0003). Overall, 21 (60%) of 35 patients reported slight to complete improvement of voiding symptoms after 3 weeks. Among the initial responders followed up for 6 months, the mean IIQ-7 score improved from 20.6 to 15.1 ( P = 0.008) and the mean UDI-6 score improved from 16.9 to 13.5 ( P = 0.008). Mild hematuria, pelvic pain, and dysuria were seen in 7 patients, lasting for 3 days or less after the procedure. Botulinum-A toxin injections may provide improvement in symptoms associated with bladder overactivity in a subset of patients. Improvement may be seen for at least 6 months after treatment. The procedure was well tolerated with minimal side effects. Additional study to define the role of injections in a broad group of patients with irritative voiding symptoms is warranted.