Botulinum toxin therapy for neurogenic detrusor hyperactivity versus augmentation enterocystoplasty: Impact on the quality of life of patients with SCI

Abstract

To compare quality of life (QoL) in patients with spinal cord injury who underwent overactive detrusor treatment by Botulinum Toxin (BT) versus augmentation cystoplasty (AC). Prospective and descriptive study. Patients with refractory overactive bladder due to SCI were treated by at least 2 successive injections of BT or by AC. QoL was assessed using Qualiveen-30 (Q30). Clinical data and urodynamic parameters were collected and compared. Thirty patients were included between March 2013 and March 2014: 14 in arm 1 (BT injections) and 16 in arm 2 (AC). Mean time interval between the interview and the last injection was 7.6 months. Mean postoperative time after AC was 9.94 years. Mean BT injections already performed was 6.36. QoL was significantly lower in arm 1–Q30 score = 1.625–versus arm 2–Q30 score = 1.077 ( p = 0.037). Continence control was significantly higher in arm 2. 14 patients were completely continent (87.5%) in arm 2 while only 6 (42.3%) were continent in arm 1 ( p = 0.0187). Urinary infection, reflux, diverticula and stones were almost at a similar occurrence level. Quality of life was found to be higher with an augmentation cystoplasty compared to BT injections. Long time intervals between two injections and advantages specific to AC might explain in part these findings.