Prospective study of the clinical and urodynamic results of intradetrusor botulinum toxin injections for the treatment of neurogenic overactive bladder

Objective. - To evaluate the clinical and urodynamic efficacy and duration of efficacy of intradetrusor botulinum toxin A (BTA) injections in patients with neurogenic overactive bladder refractory to anticholinergic therapy. Patients and methods. - Between 2004 and 2005, 33 patients (19 men and 14 women), with neurogenic overactive bladder were treated by intradetrusor injections of 300 U of BTA (Botox (R)) in 30 points. All patients were refractory to, intolerant of or presented contraindications to anticholinergic therapy. All patients voided by intermittent self-catheterization. Results. - Six weeks after BTA injections, the success rate was 75.8%, with improvement in 12.1% of cases and failure in 9.1% of cases. The mean number of self-catheterizations per 24h was significantly decreased (6.37 versus 5.2, P= 0.02), the maximum voiding volume was increased (321.68ml versus 536.25 ml, P=0.002), the mean number of episodes of incontinence per 24h was decreased (7.39 versus 0.03, P< 0.0001), the proportion of patients with incontinence was decreased (66.66%versus 6.04%, P<0.0001), the mean maximum cystomanometric capacity was increased (286.75 ml versus 554.16 ml, P=0.002) and the mean maximum intravesical pressure was decreased (54.8 cm H2O versus 5.3 cm H2O, P < 0.0001). After BTA injections, 87.8 % of patients no longer experienced uninhibited contractions. The median duration of clinical efficacy was 7.03 months. At 12 months, injections were stilt effective clinically in 21.2% of patients. Conclusion. - Intradetrusor BTA injections are an effective and well tolerated treatment for neurogenic overactive bladder. Their clinical efficacy persisted for more than 12 months in more than 20% of cases. (C) 2008 Elsevier Masson SAS. Taus droits reserves.