Experience with Intradetrusor Injection of Botulinum-A Toxin for the Treatment of Idiopathic Detrusor Overactivity in a Single Irish Institution

Abstract

Background: Intradetrusor botulinum toxin (BTX) therapy has been shown to be effective in treating neurogenic detrusor overactivity. Recently, BTX has been extended to patients with refractory idiopathic detrusor overactivity. We report our experience in this group of patients. The aim of this retrospective study is to assess if BTX is effective and improves quality of life, using the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form and additional lower urinary tract symptom parameters. Patients and Methods: Forty-three patients had BTX (Dysport®, Ipsen) between June 2003 and December 2006. All patients were sent postal questionnaires. The response rate was 67% (29/43). Results: Mean age was 52 years (range 22–75 years) and mean follow-up was 23 months (range 7–47 months). Twenty-one of 29 (73%) patients had an improvement in nocturia, 5/29 (17%) were unchanged and 3/29 (10%) were worse following treatment (p = 0.0012). Seventeen of 29 (59%) patients had a reduction in daytime frequency, 10/29 (34%) were unchanged, 2/29 (7%) were worse following treatment (p = 0.0005). Twenty-two patients leaked at night, of which 16 (73%) improved significantly, 4 (18%) were unchanged and 2 (9%) got worse after treatment (p = 0.0016). Twenty-seven of 29 patients leaked in the daytime, of which 17 (63%) improved significantly, 9 (33%) were unchanged and 1 (4%) worsened after treatment (p = 0.0001). Nineteen of 29 (66%) patients reported an improvement in how much leakage interfered with their daily lives and 10/29 (34%) were unchanged after treatment (p < 0.0001). Seventeen of 29 (59%) patients reported an improvement in their overall symptom score and 12/29 (41%) were unchanged (p = 0.0001). Eight of 29 (28%) patients required a period of clean intermittent self-catheterization after treatment. Conclusion: BTX is very effective as a treatment for refractory idiopathic detrusor overactivity.