Abstract

ABSTRACT:
BACKGROUND:
The overactive bladder (OAB) is extremely common. The treatment of refractory overactive bladder conditions has changed radically over the last decade. The efficacy of OAB treatment protocols in improving patient symptoms are not satisfactory, so new agents such as botulinum-A toxin must be investigated.
OBJECTIVE:
To evaluate the safety and efficacy of intradetrusor botulinum -A toxin injection in patients with idiopathic detrusor overactivity resistant to anticholinergic drugs.
METHODS:
From March 2010 to September 2011, 38 women with refractory idiopathic detrusor overactivity (IDO), from the urologic consultation department in Baghdad Medical City and Al-Ramadi teaching hospital, were included in this prospective study. Their age ranged from 45 to 70 years. Inclusion criteria were women with idiopathic detrusor overactivity not responding to different anticholenergic treatments. Patients with urinary tract infection, mixed incontinence, bladder stone, hematuria, neurogenic detrosur overactivity, high postvoiding residual urine volume (more than 50 ml) and history of bladder tumour were excluded from this study. Full clinical and urodynamic evaluations were done before intradetrusor injection of 300 units of botulinum-A toxin and at 2 weeks and 24 weeks after injection.
RESULTS:
Thirty six patients achieved urinary continence (94.7%). The age ranged from 45 to 70 years (mean 56.67±7.34). There was significant clinical improvement after botulinum toxin injection at both 2 weeks and 24 weeks of follow up as reflected by statistically significant decrease in the daytime frequency, nocturia and the incontinence episodes (p value <0.05).
There was significant urodynamic improvement after botulinum toxin injection at both 2 weeks and 24 weeks of follow up as reflected by statistically significant increase in the maximum cystometric bladder capacity and the bladder compliance and by statistically significant decrease in the detrusor pressure at maximum flow rate (p value <0.05). Postvoiding residual urinary volume shows statistically significant increase at both 2 weeks and 24 weeks of follow up (p value <0.05)
CONCLUSION:
The use of intradetrusor injection of botulinum toxin-A (BTX A) in refractory idiopathic detrusor overactivity was well tolerated and demonstrated clinically meaningful and statistically significant improvement in the clinical and urodynamic parameters of the patients. The effect was durable for the period of study which is 6 months