Eight-year experience with botulinum toxin type-A injections for the treatment of nonneurogenic overactive bladder: are repeated injections worthwhile?

Shannon H K Kim; David Habashy; Sana Pathan; Vincent Tse; Ruth Collins; Lewis Chan

doi:10.5213/inj.1630450.225

Eight-year experience with botulinum toxin type-A injections for the treatment of nonneurogenic overactive bladder: are repeated injections worthwhile?

Shannon H K Kim, David Habashy^*, Sana Pathan, Vincent Tse, Ruth Collins, Lewis Chan

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Purpose: To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drugrefractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome.

Methods: Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson's chi-square tests.

Results: Fifty-two patients with a mean age of 67.4 years (range, 26-93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9-101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥ 70 years) and younger (< 70 years) patient cohorts.

Conclusions: Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.

Original language	English
Pages (from-to)	40-46
Number of pages	7
Journal	International Neurourology Journal
Volume	20
Issue number	1
DOIs	https://doi.org/10.5213/inj.1630450.225
Publication status	Published - 1 Mar 2016
Externally published	Yes

Bibliographical note

Copyright the Publisher 2016. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

botulinum toxins
urinary bladder, overactive
urodynamics
treatment outcome

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10.5213/inj.1630450.225

Publisher versionFinal published version, 279 KBLicence: CC BY-NC

Cite this

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title = "Eight-year experience with botulinum toxin type-A injections for the treatment of nonneurogenic overactive bladder: are repeated injections worthwhile?",

abstract = "Purpose: To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drugrefractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome. Methods: Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson's chi-square tests. Results: Fifty-two patients with a mean age of 67.4 years (range, 26-93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9-101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥ 70 years) and younger (< 70 years) patient cohorts. Conclusions: Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.",

keywords = "botulinum toxins, urinary bladder, overactive, urodynamics, treatment outcome",

author = "Kim, {Shannon H K} and David Habashy and Sana Pathan and Vincent Tse and Ruth Collins and Lewis Chan",

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year = "2016",

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T1 - Eight-year experience with botulinum toxin type-A injections for the treatment of nonneurogenic overactive bladder

T2 - are repeated injections worthwhile?

AU - Kim, Shannon H K

AU - Habashy, David

AU - Pathan, Sana

AU - Tse, Vincent

AU - Collins, Ruth

AU - Chan, Lewis

N1 - Copyright the Publisher 2016. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Purpose: To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drugrefractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome. Methods: Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson's chi-square tests. Results: Fifty-two patients with a mean age of 67.4 years (range, 26-93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9-101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥ 70 years) and younger (< 70 years) patient cohorts. Conclusions: Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.

AB - Purpose: To investigate the efficacy and safety of repeated botulinum toxin type-A (BTX-A) injections for patients with drugrefractory nonneurogenic overactive bladder (NNOAB) and explore factors predictive of outcome. Methods: Data were collected from all patients receiving repeated BTX-A injections for drug-refractory NNOAB between 2004 and 2012. Trigone-sparing injections were administered under sedation with antibiotic prophylaxis. Patient characteristics including age, sex, preoperative urodynamics, injection number, BTX-A dose, complications, and patient global impression of improvement (PGI-I) scores were collected. Correlations between patient factors and outcomes were assessed by using Pearson's chi-square tests. Results: Fifty-two patients with a mean age of 67.4 years (range, 26-93 years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4 patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively. Mean follow-up time was 49 months (range, 9-101 months). Nine patients developed urinary tract infection; additionally, 3 patients experienced transient urinary retention. Median PGI-I score was 2 out of 7 (interquartile range [IQR], 2). For 46 patients, the PGI-I score remained stable with the administration of each injection. Pearson chi-square tests revealed that male patients or reduced bladder compliance was associated with a higher (worse) PGI-I score. Median PGI-I scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively; additionally, median PGI-I scores for those with normal bladder compliance and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR, 1), respectively. Median PGI-I scores and complication rates were the same in the older patient (≥ 70 years) and younger (< 70 years) patient cohorts. Conclusions: Efficacy is maintained with repeated BTX-A injections. Patients including the elderly show a good degree of tolerability with a low complication rate. Male patients or reduced bladder compliance is associated with poorer outcomes.

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Eight-year experience with botulinum toxin type-A injections for the treatment of nonneurogenic overactive bladder: are repeated injections worthwhile?

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