Introduction and aim of the study: In this ongoing prospective, non randomized, ongoing study we evaluated the Tolerability, efficacy and durability of response of intravesical injection of botulinum toxin type A into detrusor muscle in patients with refractory idiopathic detrusor overactivity using flexible cystoscopy under local anesthesia.
Materials and methods: A total of 43 patients with a mean age of 35 women and 8 men with a mean age of 62 years (range 25–84) with refractory idiopathic detrusor overactivity (IDO) were all treated with injections of 100–200 units of botulinum toxin A ® (Allergan Inc., Irvine, CA, USA) into the bladder with the guidance of a flexible cystoscopy. All the patients completed a micturition diary and had both urinalysis and urodynamics (pressure-flow studies) before treatment. The severity of symptom was quantified using the ICS OAB questionnaire. This was completed pre-procedure and at six weeks afterwards. Pain score was evaluated with the 0-10 Numeric Pain rating Scale immediately after the procedure. Post micturition urine volume was measured six weeks after the procedure.
Results: After six weeks 84% of the patients reported a reduction in symptom score by 4 points or more (range −4 to −16); 11. 4% reported no change in symptom score and 4.6% patients reported a worsening of symptom score by 2 points (+2). Mean reduction in OAB score was −4.3. There was significant reduction in urgency (p < 0.00001). The Mean pain score was 3.5 (range 0–8).
Interpretation of results: Botulinum toxin-A using flexible cystoscopy was well tolerated and demonstrated significant and clinically relevant improvements in all (IDO) symptoms.
Conclusions: Intradetrusor botulinum toxin-A injection using and flexible endoscopy is a well tolerated and effective procedure to manage patients with refractory (IDO) in an office setting.
© 2017 Published by Elsevier Inc.