Long-term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity
| Autor: | Emmanuel Chartier Kastler, Isabelle Vaugier, Laetitia Falcou, Brigitte Schurch, Pierre Denys, Pierre-Olivier Bosset, Mélanie Popoff, Sandra Pottier, Charles Joussain, Véronique Phé, Jonathan I. Levy, Alexia Even |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Multivariate analysis Urology 030232 urology & nephrology Neuro-Urology Kaplan-Meier Estimate Injections 03 medical and health sciences 0302 clinical medicine Refractory Risk Factors Clinical endpoint Medicine Humans Intermittent Urethral Catheterization Treatment Failure Botulinum Toxins Type A Urinary Bladder Neurogenic Update in Urology Survival analysis Retrospective Studies Univariate analysis Urinary bladder business.industry Proportional hazards model Urinary Bladder Overactive Muscle Smooth Middle Aged Botulinum toxin Survival Analysis Urodynamics medicine.anatomical_structure Administration Intravesical 030220 oncology & carcinogenesis Female Neurology (clinical) business medicine.drug |
| Zdroj: | International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology |
| ISSN: | 1520-6777 |
| Popis: | Aims Aims of this study were to assess the long-term outcomes of Intradetrusor injection of OnabotulinumtoxinA (Botox® injection) associated with clean intermittent-catheterization (CIC) for the treatment of neurogenic detrusor overactivity (NDO) and to identify risk factors for failure. Methods Neurological patients with NDO using CIC who had received Botox® injections between January 2001 and September 2013 were included. Clinical, urodynamic and radiological data were recorded. Primary endpoint was failure and withdrawal rates after 3, 5, and 7 years of management. Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method. Risk factors for failure were determined with univariate analysis and multivariate analysis using Cox model. Results Overall, 292 patients, mean age of 40 ± 13, 6 years, were included. Overall, 219 patients (80.6%; IC95% [76.3-85.4%]) were still treated with Botox® injections after 3 years, 128 (71.1%; IC95% [65.7%, 76.9%]) after 5 years, and 58 (60.8%, IC95% [54.0%, 68.4%]) after 7 years. Failure rate was 12.6% (IC95% [8.6-16.5%]) after 3 years, 22.2% (IC95% [16.6-27.3%]) after 5 years, and 28.9% (IC95% [21.9%; 35.3%]) after 7 years of follow-up. Withdrawal rate after 7 years of follow-up was 11.3% (n = 33/292). Severe NDO at baseline appears to be a significant risk factor for failure. Conclusion This study confirms long-term efficacy and tolerance of Botox® injection in patients with NDO using CIC. Long-term failure and withdrawal rates remain low but significant, and need to be managed. |
| Databáze: | OpenAIRE |
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