Abobotulinumtoxin A in Idiopathic Hyperactive bladder - ethical issues

Abobotulinumtoxin A (ABO) is a promising member of the botulinum toxin family with positive results in clinical trials on idiopathic overactive bladder (OAB) patients refractory to conservative treatment. We aimed to present the impact of complications following ABO treatment on the quality of life of a patient treated in our department. Methods. In 2012 we started a local trial aimed to asses the role of ABO injections in urodynamically-confirmed OAB patients. We included a 56-year-old female patient with idiopathic OAB and urodynamically-proven mixed urinary incontinence treated with transobturatory sling in another medical facility. Results. After drug administration (500 U), the patient accused bladder pain and transient hematuria, remittent in the following days using antiinflamatory drugs. At 1 month, an increased PVR (Post Void Residue) of 220 ml was found, combined with chronic urine retention and a persistent urinary tract infection. Clean Intermittent Self Catheterization (CISC) was started along with wide-range antibiotics. The urinary retention finally ceased at 12 months and CISC was stopped. Unfortunately, this was followed by a relapse in OAB symptoms. The onset of urinary retention and the necessity of CISC had a profound negative impact on the patient, ranging from depression towards suicidal thoughts. Conclusions. Intradetrusor Abobotulinumtoxin A is a feasible treatment method although it requires a thorough screening of potential patients. As OAB patients with/without urinary incontinence have a predisposition for depression and other psychological issues, a thorough psychological or even psychiatrical assessment would be recommended in such cases.