The outcome of intravesical onabotulinum toxin injections for salvage therapy of refractory detrusor overactivity following augmentation enterocystoplasty

Abstract

Objective: The objective of this article is to assess the effect of intravesical onabotulinum toxin A (OBTX-A) injections in patients with persistent/refractory symptomatic detrusor overactivity (DO) and urge urinary incontinence (UUI) following previous augmentation enterocystoplasty. Patients and methods: We conducted a retrospective review of all patients with previous augmentation enterocystoplasty having intravesical OBTX-A for persistent/refractory DO and UUI. Information on demographics, original diagnosis, date and technique of enterocystoplasty, dose of OBTX-A and symptomatic outcomes was recorded. Results: Fifteen patients (three men) with mean age 42 years were studied. Eight out of 15 (53%) reported complete continence or significant improvement, while the remaining seven (47%) noticed no difference in their symptoms. Urodynamics were repeated in these seven patients and persistent DO was confirmed. Four out of five (80%) NDO patients who received 300 U of OBTX-A reported a favourable outcome, whereas a favourable response was noted in only four out of 10 IDO (40%) when smaller amounts of OBTX-A (100 U or 200 U) were used. Conclusions: Intravesical OBTX-A injections completely resolved or significantly improved persistent/recurrent symptoms of DO in 53% of patients with a previous augmentation enterocystoplasty. The success rate was higher for those receiving the higher dose of 300 U and/or those with NDO.