Abstract
ObjectivesTo analyze the predictors of therapeutic efficacy after intravesical botulinum toxin A injection for overactive bladder syndrome (OAB) refractory to antimuscarinic therapy.MethodsAll consecutively OAB patients, who visited the urologic outpatient clinics of a medical center and refractory to antimuscarinic treatment, were prospectively enrolled. All enrolled patients received intravesical injection of 100 U onabotulinumtoxinA (Botox). The Global Response Assessment (GRA) score ≥ 2 at 3 months after Botox injection was defined as a successful treatment, otherwise failed.ResultsOverall, 89 patients received intravesical injection. Eighty patients, including 42 men and 38 women, had received follow-up at 3 months. The overall success rate was 63.8%. The global response assessment, urgency severity score, urgency, urgency urinary incontinence and frequency episodes, and functional bladder capacity improved after treatment. However, post-void residual volume (PVR) increased, and voiding efficiency (VE) decreased after treatment. Female gender (odds ratio = 3.75) was the only independent factor associated with the success. Female gender (coefficient = 0.74), low baseline overactive bladder symptoms score (coefficient = -0.12) and the presence of OAB-wet (coefficient = 0.79) were independent factors associated with therapeutic efficacy (i.e., GRA score). VE (odds ratio = 0.062) was the only predictor for a large PVR at 3 months. The optimum cutoff value of VE was <87% with the area under the ROC curve being 0.64 (sensitivity = 63.8%, specificity = 57.1%).ConclusionsThe therapeutic effects of Botox can persist till 6 months after treatment. Female gender, low overactive bladder symptoms score and OAB-wet are associated better therapeutic efficacy, and low baseline VE is associated with large PVR. These findings can serve as an initial guide or assist in consultation regarding the treatment of OAB patients with Botox injection.Trial RegistrationClinicalTrials.gov NCT01657409
Highlights
Overactive bladder syndrome (OAB) is characterized by urgency with or without urge incontinence, usually with frequency and nocturia [1]
The therapeutic effects of Botox can persist till 6 months after treatment
These findings can serve as an initial guide or assist in consultation regarding the treatment of OAB patients with Botox injection
Summary
Overactive bladder syndrome (OAB) is characterized by urgency with or without urge incontinence, usually with frequency and nocturia [1]. Urothelial dysfunction and abnormalities of sensory receptor expression or transmitter release in the suburothelial nerves may contribute to OAB, which is refractory to antimuscarinics [3]. Intravesical treatment to inhibit abnormal receptor expression or transmitter release in the suburothelial space provides good therapeutic effects for the treatment of OAB [4]. Intravesical botulinum toxin A (BoNT-A) injection for OAB refractory to antimuscarinic therapy has emerged as a good treatment of choice. BoNT-A injection has both motor and sensory effects [5]. Despite a good therapeutic effect for BoNT-A injection was demonstrated in OAB, the resulting detrusor contractility impairment and large post-void residual volume (PVR) remained an important problem to be solved [6,7,8]
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