Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: An objective and subjective analysis
| Autor: | T. Stolze, Helmut H. Knispel, Heinrich Schulte-Baukloh, Schobert J, C. Weiß, B. Stürzebecher |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Male Multiple Sclerosis Urology urologic and male genital diseases Patient satisfaction Refractory Surveys and Questionnaires medicine Humans Nocturia Prospective Studies Botulinum Toxins Type A Urinary Bladder Neurogenic Prospective cohort study Aged business.industry Multiple sclerosis Middle Aged medicine.disease Botulinum toxin female genital diseases and pregnancy complications Urodynamics Neuromuscular Agents Overactive bladder Patient Satisfaction Anesthesia Reflex Female Neurology (clinical) medicine.symptom business Follow-Up Studies medicine.drug |
| Zdroj: | Neurourology and Urodynamics. 25:110-115 |
| ISSN: | 1520-6777 0733-2467 |
| Popis: | Aims We studied the use of botulinum-a toxin (BTX-A) injections into the bladder as an alternative approach in patients with neurogenic detrusor overactivity due to multiple sclerosis (MS) with drug-refractory overactive bladder (OAB) symptoms. Methods Sixteen MS patients—11 women, 5 men; mean age 48.6 years—with refractory OAB symptoms were included in a one-center prospective study. For outcome analysis, we used a bladder diary, a complete urodynamic study, and validated questionnaires for subjective assessment. We injected 300 U of BTX-A (Botox®) into the bladder and into the external sphincter muscle to reduce the probability of posttreatment urine retention. Results There was an increase in residual volume from 81.3 ± 23.8 to 126.3 ± 32.9 ml after 4 weeks. In one woman, transient self-catheterization was unavoidable. Four weeks and 3 and 6 months after BTX-A injection, the significant results were as follows: daytime frequency was reduced by 29%, 44%, and 30%, respectively. Nocturia diminished by 33%, 72%, and 40%. Use of pads was be reduced by 38% after 4 weeks and by 64% after 3 months. Urodynamically, reflex volume and maximal cystometric bladder capacity increased by 73%, 77%, and 58% (at 6 months, the increase was not significant) and by 36%, 27%, and 36% (not significant). Maximal detrusor pressure decreased by 35%, 22%, and 57%. Subjective outcome indicated significant improvement of symptoms at 4 weeks and 3 months, but not at 6 months. Patient satisfaction with the therapy was very high. Conclusions BTX-A detrusor injections are very effective in the treatment of drug-resistant OAB symptoms in MS patients as reflected in urodynamic measurements and in patient satisfaction. Build up of residual urine remains a problem of which patients must be informed. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. |
| Databáze: | OpenAIRE |
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