(PD2-5) Safety and efficacy of botulinum toxin a treatment for patients with detrusor overactivity and inadequate contractility
  • 2015-11-30,
  • 上傳者: TUA秘書處,
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花蓮慈濟醫院 泌尿科
Safety and efficacy of botulinum toxin a treatment for patients with detrusor overactivity and inadequate contractility
Shu-Yu Wu, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University Hualien, Taiwan
Overactive bladder (OAB) is common in older adults and is associated with substantial impairment in mental health and quality of life. Part of the patients with underactive bladder (UAB) or detrusor underactivity (DU) may have both detrusor hyperactivity and inadequate contractility (DHIC), resulting in UUI and large PVR. Botulinum toxin A (BoNT-A) significantly improves OAB symptoms and urodynamic parameters in OAB. However, the increased PVR volume and risk of urinary tract infection (UTI) may show after BoNT-A treatment.
Materials and Methods:
This study retrospectively analyzed the therapeutic efficacy and safety in OAB patients who had a baseline PVR >100ml or VE <67% and received intravesical BoNT-A 100U injections A total of 21 patients with urodynamically proven DHIC and 21 age-matched controlled OAB patients with urodynamic DO were selected from our previous clinical trials. Patients of either gender, aged ≥20 years, with urodynamic DO and at least one episode of urgency (urgency severity scale [USS] score ≥2) or urgent urinary incontinence (UUI) per day, as recorded in a 3-day voiding diary, were enrolled. All patients had been managed with behavioral modification and treated with a certain number. Patients were treated with suburothelial injections of 100 U BoNT-A, total 20 injections in the bladder body, sparing the trigone. All patients were evaluated at baseline, 2 weeks, and 1, 3, and 6 months after treatment. The common AEs included acute urinary retention (AUR) (severe difficulty urinating with a PVR volume >250 mL and necessitating theuse of an indwelling catheter or CIC), gross hematuria, and general weakness during the early stage and a large PVR volume >250 mL, straining to void (experiencing difficulty urinating and requiring abdominal straining to empty the bladder, which was not experienced before treatment), and UTI (symptomatic or asymptomatic with a WBC count > 10/HPF in urinalysis) during the follow-up period.
The mean age of DHIC and OAB patients were 71.2±8.2 and 70.9 ±14.1 years, respectively. The subjective symptom scores after BoNT-A, including OABSS, USS, PPBC and GRA all showed significantly improved in both groups and no difference between groups. However, the changes of urgency episodes per 3 days were only noted in OAB patients after BoNT-A injection. UUI was significantly improved at 3 months and frequency episode was significantly improved at 6 months in OAB patients, but not in DHIC patients. Interestingly, there was no increase of bladder capacity or voided volume in either group. Qmax showed no significant change after BoNT-A injection in either group. PVR increased in DHIC patients at 2 and 4 weeks, but not at 3 and 6 months after BoNT-A injection. However, in OAB patients, the significant increase of PVR was noted at 2 months and lasted to 6 months. VE also showed the same changes as that noted in PVR in DHIC and OAB patients. AUR was noted in 7 and 3 patients, large PVR >250ml in 12 and 7 patients, difficult urination in 15 and 14 patients, and UTI in 8 and 4 patients of DHIC and OAB patients, respectively. After BoNT-A injection, 7 DHIC patients and 16 OAB patients considered the treatment was effective in improving quality of life. Among these patients, the therapeutic efficacy lasted for a mean of 2.3 months and 4.5 months in DHIC and OAB patients, respectively.
Patients with DHIC might not benefit from intravesicl BoNT-A injection for their OAB symptoms. The urgency episodes are not decreased after BoNT-A injection and the therapeutic duration is significantly shorter than that of OAB patients.
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    2015-11-30 10:41:00
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