Abstract
Women with drug refractory neurogenic mixed incontinence (NMI) have limited minimally invasive treatment options and require reconstructive surgery. We examined efficacy of a combination of day case intradetrusor (ID) botulinum toxin (BTX-A) bladder injections and transobturator (TOT) or tension free vaginal tape (TVT). Eleven women who are pharmacotherapy intolerant or who have drug refractory NMI were treated. Two opted for open surgery and the remaining 9 received 1000 units of Dysport diluted in 30 mL saline cystoscopically at 30 ID sites followed by TOT in 6 or TVT in 3 as a day case combination treatment. Patient demographics, pre and post treatment videocystometrogram (VCMG), pad test and International Committee on Incontinence Questionnaire (ICIQ) scores were recorded. At 6 weeks (repeat ICIQ, pad test and patient satisfaction), at 3 and 12 months (VCMG) and 'current' (ICIQ and patient satisfaction) was recorded. The mean age was 56.7 years (range 41 to 78) with a mean follow up of 19.1 months (range 7 to 33). All women were continent at 3 and 12 months. Quality of life (ICIQ scores) improved at 6 weeks (p > 0.001) and remained stable up to the last follow up (p > 0.001). Eight women have stopped using pads. At 3 months, there was significant improvement in MDP (p > 0.014) and MCC (p = 0.002). Anticholinergics were discontinued in 7 with global high satisfaction with the treatment BTX-A injections were repeated in 4 (mean 13.5 months). Anticholinergic refractory women with NMI can be effectively treated as a day case with combination of ID BTX-A injections and TVT or TOT.
Highlights
Various epidemiological studies based on analysis of postal surveys and interviews using different questionnaires report the prevalence of mixed urinary incontinence (MUI) in the general population in the range varying from 11% to 61% with a mean of
Starting in April 2003, we identified a total of 22 women with traumatic spinal cord injury who had urodynamic stress incontinence (USI) and neurogenic detrusor overactivity (NDO) or loss of compliance (LOC)
To date the satisfaction scale is unchanged in all and the Incontinence Questionnaire (ICIQ) scores remain significantly lower than pre-operative scoring (Table2)
Summary
Various epidemiological studies based on analysis of postal surveys and interviews using different questionnaires report the prevalence of mixed urinary incontinence (MUI) in the general population in the range varying from 11% to 61% with a mean of29% [1]. Surgical interventions alone (such as suburethral slings or periurethral bulking agents) should be used with caution without effective control over high detrusor pressures [6, 7] and may be ineffective – in patients with high amplitude bladder contractions [7]. In these patients, the only effective treatment options thereafter are sacral anterior root stimulator implant (SARSI) with posterior rhizotomy or CLAM ileocystoplasty and suburethral sling or colposuspension. These major surgical interventions may be unappealing to most patients due to their irreversible nature, morbidity (acute and chronic) and mortality
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