PD36-06 THE EFFICACY OF ONABOTULINUMTOXIN A IN PATIENTS WITH PARKINSON′S DISEASE AND NEUROGENIC DETRUSOR OVERACTIVITY

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction II1 Apr 2018PD36-06 THE EFFICACY OF ONABOTULINUMTOXIN A IN PATIENTS WITH PARKINSON′S DISEASE AND NEUROGENIC DETRUSOR OVERACTIVITY Ranjan Arianayagam, Lewis Chan, and Vincent Tse Ranjan ArianayagamRanjan Arianayagam More articles by this author , Lewis ChanLewis Chan More articles by this author , and Vincent TseVincent Tse More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1729AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with Parkinson′s Disease (PD) and extrapyramidal syndromes often report voiding dysfunction and overactive bladder symptoms. Onabotulinum Toxin A (BTXA) injections has proven efficacy in the treatment of neurogenic overactive bladder. We report the efficacy of intravesical BTXA injections for treatment of drug refractory detrusor overactivity in patients with PD. METHODS A retrospective review of patients with drug refractory overactive bladder who underwent BTXA (Botox) at Concord Hospital from 2007 to 2017 was conducted. All patients underwent multichannel urodynamic assessment. Urodynamic findings were reviewed and clinical outcomes obtained from medical records. RESULTS 12 patients (mean age 75) had PD and 1 patient had supranuclear palsy. 2 patients had high pressure detrusor overactivity (DO) on urodynamics, 4 patients had decreased compliance and the remainder had low amplitude DO. 2 patients had raised post void residuals on urodynamics and the remainder had a normal voiding phase with no bladder outlet obstruction.10 patients had an initial 100 unit Botox injection; 3 patients (including 2 with high pressure DO), had 200 units initially, and 5 patients had dose escalation from an initial 100 units. 6 patients (46%) had significant improvement in their storage symptoms after BTXA and 3 patients (23%) reported mild improvement. Only 1 of 5 patients had an improvement with dose escalation. Overall, 9 of 13 patients (69%) reported an improvement in their symptoms. The majority of patients had some ongoing storage symptoms despite Botox and only 2 (15%) regained total continence.Post-operatively, 4 patients (31%) had elevated post void residuals, 3 of whom had a normal voiding phase on urodynamics. Of these, 2 required temporary clean intermittent self catheterization and one required a long term SPC. This is significantly higher than the 2% rate of retention post BTXA for patients with non-neurogenic overactive bladder at our institution and may represent impaired voiding function in the context of progressive neurodegenerative disease. CONCLUSIONS Whilst the majority of patients with drug refractory neurogenic overactive bladder related to PD reported some symptom improvement following BTXA, only 50% had good response. One third of patients had elevated residuals. Our study shows lower efficacy of BTXA therapy and a higher retention rate in PD patients and illustrates the difficulty in the management of neurogenic detrusor overactivity in patients with progressive neurodegenerative disease. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e728 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ranjan Arianayagam More articles by this author Lewis Chan More articles by this author Vincent Tse More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...