Outcomes after Botulinum toxin type A-Injection in detrusor vesica in patients undergoing robot-assisted radikale Prostatectomy( RARP).
Vahudin Zugor, Alayham Abdulhak, Mustapha Addali, Jörn Witt
Introduction & objective: To evaluate symptomatic effects of intraoperative botulinum toxin type A (BTX-A) –injection in patient underwent robot-assisted radikale Prostatectomy (RARP) for treating idiopathic detrusor overactivity (IDO) including those with abnormally low bladder compliance.
Methods: From March 2011 to December 2012, N=14 patients with a histological conformation of PCa, an urodynamic diagnosis of IDO with or without incontinence , absence of hormonal or infective Pathology, no associated or contributing neurological in 12 patients (2 patient with Parkinson´s disease), obstructive Pathology was in only one patient, underwent RARP. N=13 patients were urodynamic assessed with cystometry using a filling rate of 50 ml/min. Before the operation took place, all patients were injected 100 units of (BTX-A) with 10 ml of normal saline, intradetrusally at the rate of 0,5 ml at each site for 20 sites of the posterior wall, lateral wall and the dome of the bladder sparing the trigone and ureteric orifices. After discharge, all patients underwent rehabilitation for 3-4 weeks. All 14 patients were evaluated in terms of urgency, frequency, nocturia, incontinence and functional bladder capacity (FBC) preoperative and in period from 4-6 weeks.
Results: The median age of the patients was 60 years (58-77) N=13 patients (93,75), had preoperative an IDO with incontinence, exhibited exceptional improvements in frequency, urgency and nocturia. Furthermore, they demonstrated an absence of urge incontinence and a 36,36% mean increase of their FBC (mean 253,8 ml to mean 345,8 ml). N=1 patient (6,25), exhibited with no improvement of the urge symptoms .
Conclusions: The results of this study indicate that the simultaneous use of BTX-A in such patients could normalise micturition frequency, diminish urge incontinence. However, due to the small amount of patients involved in this study a prospective trial with more patients is warranted to assess the impact of these results on clinical practice.