Abstract
ABSTRACTPurpose To assess the response in spinal cord injured patients alternatively treated with different types and dosages of Botulinum neurotoxin type A (BoNT/A) over 15 years.Material and methods Patients who underwent first BoNT/A from 1999-2001 and practiced intermittent catheterization were included. Baseline 3-day bladder diary (BD) and urodynamics were collected. BoNT/A failure was defined when patients asked for re-injection ≤ 3 months post-treatment. Criteria for re-injection was at least one daily episode of urinary incontinence at BD. Before re-injection, patients were asked if they had reached 6 months of dryness without antimuscarinics (YES response).Results Overall, 32/60 (53.4%) “No failure” (NF) group; 16 (26.6%) “occasional failure” (OF) and 12 (20%) “consecutive failure” (CF) were included. A total of 822 BoNT/A infiltrations were performed. The mean interval from previous injection to treatment re-scheduling was 8 months. No significant differences between treatments were found within the three groups (p>0.05). The percentage of YES responses increased from 19% (AboBoNT/A 500IU) to 29 % (OnaBoNT/A 300IU) in NF, and from 18% (AboBoNT/A 500IU) to 25% (OnaBoNT/A 300IU) for OF. Five NF cases (15.6%) maintained 6 months of dryness after each injection. Among the baseline variables, only low compliance (< 20mL/cmH2O) was found as predictor for failure (p=0.006).Conclusions Long term BoNT/A for NDO did not increase failures, independent of the types of treatments and switching. Definition of failure and other criteria for continuing repetitive BoNT/A treatment is mandatory. CF was predictable for no response in earlier follow-up.
Highlights
One of the major health problems in patients with spinal cord injury (SCI) is bladder dysfunction
Literature reports a high percentage of patients who have gained clinical and urodynamic benefits after botulinum neurotoxin type A (BoNT/A), achieving urinary continence, increasing bladder capacity, reducing detrusor pressures in patients refractory to antimuscarinics [5,6,7,8]
Aim of the study In this retrospective study, we report the experience of our patients affected by neurogenic detrusor overactivity (NDO), treated with two types of BoNT/A (Botox® and/ or Dysport®) at different dosages during a 15-year follow-up
Summary
One of the major health problems in patients with spinal cord injury (SCI) is bladder dysfunction. Literature reports a high percentage of patients who have gained clinical and urodynamic benefits after BoNT/A, achieving urinary continence, increasing bladder capacity, reducing detrusor pressures in patients refractory to antimuscarinics [5,6,7,8]. Both BoNT/A injections, Abobotulinumtoxin (Dysport®, Ipsen Biopharm, Slough, UK) as well as Onabotulinumtoxin (Botox®, Alleribju | Long term Botulinum toxin A for NDO gan, Irvine, CA, USA), have been proven to be safe with a positive impact on quality of life [9,10,11,12,13,14,15].
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Schedule a callMore From: International braz j urol : official journal of the Brazilian Society of Urology
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