Intra-Detrusor Injection of Botulinumtoxin in Patients with Refractory Overactive Bladder

Overview

Introduction:
Symptoms of overactive bladder affect the quality of patients’ life significantly. There is a standard treatment consisting in application of anticholinergics or possibly other conservative methods. This treatment fails at a certain part of patients however. While radical surgical therapy used to be offered to such patients in the past, the botulinumtoxin injection is available at present. The aim of the paper is to assess the efficacy and safety of this treatment method in own set of female patients with refractory overractive bladder.

Material and methods:
The set totals of 16 female patients with refractory overactive bladder. The average age in the set is 52.7 (38–69) years. Patients were treated by the application of botulinumtoxin in the period 6/2004 – 12/2006; the follow-up is 21.6 (6–36) months. In all cases the Dysport preparation in the dose 1000 UI was used for application. Botulinumtoxin has been applied during a short endoscopic procedure using a flexible needle into 40 points in the detrusor. Subjective satisfaction, data from voiding diaries, urodynamic parameters and the duration of effect persistence were evaluated.

Results:
Subjective satisfaction with the treatment result was reached in 13 (81.3%) patients. In 12 (75.0%) patients the full continence was obtained.

Average urinary bladder evacuation frequency decreased from 15.8/24 h to 5.5/24 h after the treatment, the number of urgency episodes decreased from 7.7/24 h to 0.8 /24 h while average evacuated volume increased from 107.9 to 329.0 ml.

The maximum cystometric capacity increased from 151.9 ml to 311.2 ml while maximum detrusor pressure decreased from 31.0 to 14.3 cm H₂O at urodynamic assesment.

The changes in all monitored parameters were statistically significant. The effect duration was 10.3 (6-13) months. No side effects of the application were registered during the treatment.

Conclusion:
The application of botulinumtoxin into detrusor is an effective and safe treatment method for refractory overactive bladder. Final standardization of the treatment by botulinumtoxin additional studies focused especially to the research of the relation among the dose, solution and clinical effect are necessary.

Key words:
botulinumtoxine, hyperactive bladder, detrusor, continence, cystometric capacity, detrusor pressure