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Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis.
Neurourol Urodyn. 2006; 25(2):110-5.NU

Abstract

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.

Authors+Show Affiliations

Department of Urology, St. Hedwig Hospital, Academic Teaching Hospital of Charité University Hospital, Berlin, Germany. hschultebaukloh@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

16470519

Citation

Schulte-Baukloh, H, et al. "Efficacy of botulinum-A Toxin Bladder Injections for the Treatment of Neurogenic Detrusor Overactivity in Multiple Sclerosis Patients: an Objective and Subjective Analysis." Neurourology and Urodynamics, vol. 25, no. 2, 2006, pp. 110-5.
Schulte-Baukloh H, Schobert J, Stolze T, et al. Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis. Neurourol Urodyn. 2006;25(2):110-5.
Schulte-Baukloh, H., Schobert, J., Stolze, T., Stürzebecher, B., Weiss, C., & Knispel, H. H. (2006). Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis. Neurourology and Urodynamics, 25(2), 110-5.
Schulte-Baukloh H, et al. Efficacy of botulinum-A Toxin Bladder Injections for the Treatment of Neurogenic Detrusor Overactivity in Multiple Sclerosis Patients: an Objective and Subjective Analysis. Neurourol Urodyn. 2006;25(2):110-5. PubMed PMID: 16470519.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis. AU - Schulte-Baukloh,H, AU - Schobert,J, AU - Stolze,T, AU - Stürzebecher,B, AU - Weiss,C, AU - Knispel,H H, PY - 2006/2/14/pubmed PY - 2006/5/2/medline PY - 2006/2/14/entrez SP - 110 EP - 5 JF - Neurourology and urodynamics JO - Neurourol Urodyn VL - 25 IS - 2 N2 - 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. SN - 0733-2467 UR - https://www.unboundmedicine.com/medline/citation/16470519/Efficacy_of_botulinum_A_toxin_bladder_injections_for_the_treatment_of_neurogenic_detrusor_overactivity_in_multiple_sclerosis_patients:_an_objective_and_subjective_analysis_ L2 - https://doi.org/10.1002/nau.20153 DB - PRIME DP - Unbound Medicine ER -