Abstract
PurposeIntravesical injection of onabotulinumtoxinA is an effective treatment for overactive bladder (OAB). Nonetheless, the treatment outcome is unclear in OAB patients with central nervous system (CNS) lesions. This study evaluated the efficacy and safety of intravesical onabotulinumtoxinA treatment in elderly patients with chronic cerebrovascular accidents (CVAs), Parkinson’s disease (PD) and dementia.Materials and MethodsPatients with CVA, PD, dementia, and OAB refractory to antimuscarinic therapy were consecutively enrolled in the study group. Age-matched OAB patients without CNS lesions were selected to serve as a control group. OnabotulinumtoxinA (100 U) was injected into the bladder suburothelium at 20 sites. The clinical effects, adverse events, and urodynamic parameters were assessed at baseline and 3 months post-treatment. The Kaplan-Meier method was used to compare long-term success rates between groups.ResultsA total of 40 patients with OAB due to CVA (23), PD (9), dementia (8) and 160 control patients were included in this retrospetive analysis. Improvement of urgency severity scale, increased bladder capacity and increased post-void residual volume were comparable between the groups at 3 months. Patients with CNS lesions did not experience increased risks of acute urinary retention and urinary tract infection; nonetheless, patients with CVA experienced a higher rate of straining to void. Long-term success rates did not differ between the patients with and without CNS lesions.ConclusionIntravesical injection of 100 U of onabotulinumtoxinA effectively decreased urgency symptoms in elderly OAB patients with CNS lesions. The adverse events were acceptable, and long-term effects were comparable to OAB patients in general. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization need careful evaluation for this very vulnerable population before choosing intravesical onabotulinumtoxinA treatment.
Highlights
overactive bladder (OAB) is highly prevalent in elderly patients and involves both peripheral and central nervous system (CNS) factors [1]
A total of 40 patients with OAB due to cerebrovascular accidents (CVAs) (23), Parkinson’s disease (PD) (9), dementia (8) and 160 control patients were included in this retrospetive analysis
Long-term success rates did not differ between the patients with and without CNS lesions
Summary
OAB is highly prevalent in elderly patients and involves both peripheral and CNS factors [1]. The incidence of OAB increases with age, especially in patients with CNS disorders such as CVA and PD. White matter disease causing dementia increases significantly with age and can cause OAB and urinary incontinence [2]. The incidence of OAB increases with aging; degeneration of the CNS in the elderly is proposed as one of the pathogenic factors of OAB [1]. Aging and CNS lesions play key roles in the pathogenesis of OAB among elderly patients [5]. Both storage and voiding symptoms occur in patients with CNS disorders, resulting in a complex combination of complaints [6]. The HR-QoL in patients with CNS lesions and OAB is worse than in patients with OAB in general [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
