MP38-20 THE EFFICACY OF BOTULINUM TOXIN A FOR CONTROL OF URINARY INCONTINENCE IN PATIENTS WITH A SUPRAPUBIC CATHETER

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Therapy II1 Apr 2014MP38-20 THE EFFICACY OF BOTULINUM TOXIN A FOR CONTROL OF URINARY INCONTINENCE IN PATIENTS WITH A SUPRAPUBIC CATHETER Bashir Mukhtar, Shafiul Chowdhury, Mahreen Pakzad, Julian Shah, Jeremy Ockrim, Tamsin Greenwell, and Rizwan Hamid Bashir MukhtarBashir Mukhtar More articles by this author , Shafiul ChowdhuryShafiul Chowdhury More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Julian ShahJulian Shah More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , and Rizwan HamidRizwan Hamid More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1277AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are a variety of methods for bladder drainage in disease state including suprapubic catheterisation (SPC). A proportion of these patients continue to have urgency related urinary incontinence refractory to antimuscarinics. Intradetrusor Botulinum toxin A (BTX) is an accepted treatment for control of detrusor overactivity (DO). However, the efficacy of BTX in controlling incontinence in patients with SPC is not well documented. We present our experience with BTX in this setting. METHODS We compiled a retrospectively collated database of patients that between September 2012 and September 2013 had undergone intradetrusor injections of BTX into multiple sites of the bladder wall at our institution. 206 patients were identified, of which 16 had SPC as a method of bladder drainage. All but one had urodynamic proven DO with urinary incontinence. 12 had a pre-treatment diagnosis of neuropathic bladder dysfunction, with the majority of these being secondary to multiple sclerosis. 3 had idiopathic bladder dysfunction and 1 had a diagnosis of chronic pelvic pain syndrome. Data on urodynamics results, including evidence of DO, leakage, BTX dose and further treatment, was collected from the trust computer database. Associated complications, improvement in symptoms, duration of cessation of leakage and if subsequent BTX treatment was effective, was collected via clinic letters, repeat urodynamics and subjectively via a telephone interview. RESULTS The mean age of the cohort was 59 years (range; 34-77 years). Gender ratio was 12 females to 4 males (3:1). From our cohort of 16 patients, 10 reported significant improvement in symptoms with quality-of-life improving effects. 3 had no discernable improvement in symptoms. In 3 the result could not be established. 6/10 patients with improvements were cured of incontinence. Indeed, at the time of follow-up, only one had reported a relapse (at 7 months). The others were within 3,3,5,5 and 9 months of their treatment and still asymptomatic for leakage. In those that had repeat BTX within the study time, all (5/5) reported excellent efficacy. Only 1 patient experienced significant discomfort from the treatment, which resulted in cessation of the procedure. No others reported any peri-operative difficulties (15/16). CONCLUSIONS In patients with urodynamic diagnosed DO who have SPC as a means of bladder drainage, and who experience urinary incontinence that is refractory to antimuscuranics, BTX is an effective treatment option, with good tolerability and beneficial effects that appear to be sustained with repeated injections. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e410 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Bashir Mukhtar More articles by this author Shafiul Chowdhury More articles by this author Mahreen Pakzad More articles by this author Julian Shah More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Rizwan Hamid More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...