7 years of Intravesical Intramuscular Botulinumtoxin-A-Injection (IIB-A-I) in Idiopathic and Neurogenic Detrusor over activity – results and experiences of a single centre
Schahnaz Alloussi¹, Christoph Lang¹, Robert Eichel¹, Saladin Helmut Alloussi²
¹Urological Department, Städtisches Klinikum Neunkirchen, Academic Teaching Hospital of University of Saarland
²Urological Department, University Hospital Tübingen, Germany
The treatment of drug refractory Overactive Bladder is a challenge. With Botulinum toxin there is now a mainly accepted weapon in the hand of urologist. To document the effectiveness and safety a large patient population with idiopathic (IDO) and neurogenic detrusor overactivity (NDO) was treated.
Between 2002 and 2009, 170 patients with IDO and 64 patients with NDO were treated by IIB-A-I (Dysport™) under local anesthesia. The injections are performed including 3 out of 10 injection sites in the trigonum (Neunkircher Schema). The patients are diagnosed and followed up by standardized questionnaire for control of subjective parameters and objective pattern by Videourodynamic (VUD) 6 weeks within 3 month after injection. In addition to the urodynamic results, by using VUD examination it is possible to visualize the morphological situation of urinary tract.
The overall result shows in both groups a substantial improvement of functional bladder capacity and micturition volume with decrease of detrusor pressure. The subjective parameters like number of incontinence episodes, frequency or quality of live show significant improvement. The treatment was well tolerated and the appearance of post void residual in NDO was expected to improve live qualitiy by satisfactory continence using Intermitted Self Catheterisation. In IDO no clinical significant post void residual could be assessed by choosing ideal BoNT-A dosage.
- In a large patient population of one single centre BoNT-A is a safe and effective treatment for patients suffering on IDO and NDO
- The injection is easy to perform under local anaesthesia
- No unexpected or systemic side effects occurred.