1015 7 YEAR FOLLOW UP OF THE FIRST GROUP OF PATIENTS WITH NEUROGENIC DETRUSOR OVERACTIVITY RECEIVING BOTULINUM TOXIN-TYPE A (DYSPORT)

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20101015 7 YEAR FOLLOW UP OF THE FIRST GROUP OF PATIENTS WITH NEUROGENIC DETRUSOR OVERACTIVITY RECEIVING BOTULINUM TOXIN-TYPE A (DYSPORT) Ahmad Abdul-Rahman, Prasad Patki, Rizwan Hamid, and Julian Shah Ahmad Abdul-RahmanAhmad Abdul-Rahman More articles by this author , Prasad PatkiPrasad Patki More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , and Julian ShahJulian Shah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2029AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Botulinum toxin–A has shown promising results in the management of neurogenic detrusor overactivity (NDO). Most of the reports in the literature have utilised BOTOX [Allergan, Irvine, CA, USA]. We assessed the long term outcome of BTX-A (Dysport, Ipsen, Luxembourg; 1000 units) in the treatment of drug-resistant NDO in spinal cord injury (SCI) patients. METHODS We performed a retrospective analysis of 37 SCI patients with NDO who had BTX-A (Dysport, 1000 units) injected cystoscopically into the detrusor muscle in our Neuro-Urology department. The maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), NDO, continence, and anticholinergics usage were used as outcome variables. RESULTS The mean follow-up was 7 years (3-8 years). Mean BTX-A injections were 4 (1-6 injections) per patient. 20/37 patients (54%) continued to have the intradetrusor Dysport injections every 12 to 18 months with clinical and VCMG proven improvement. The MCC increased from a mean of 259 to 520 ml (p 0.0001), and the MDP decreased from a mean of 54 to 25 cmH2O (p 0.01). The incontinence and NDO were abolished in 85% and 80% respectively in this subset of patients. Anticholinergics were stopped in 15/20 (75%) patients and the remaining 5/20 patients were able to reduce the dosage. Two patients 2/37 (5.5%) failed to improve after two injection sessions and underwent Clam Ileocystoplasty. Personal convenience and infection with suprapubic pain were the reasons for 8/37 (22%) to chose to revert back to oral medications on long term after achieving significant benefit from intradetrusor Dysport. The remaining 7/37 patients (18.5%) were lost to follow up. CONCLUSIONS Injection with BTX-A (DYSPORT) is an effective and sustainable treatment of NDO in SCI patients. It bridges the gap between oral and invasive surgical treatment of drug-resistant NDO. With a low dropout rate it provides a credible alternative to surgery in patients with SCI. London, United Kingdom© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e395 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Abdul-Rahman More articles by this author Prasad Patki More articles by this author Rizwan Hamid More articles by this author Julian Shah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...