Detrusor Compliance Research Articles

Effects of solifenacin in patients with neurogenic detrusor overactivity as a result of spinal cord lesion

Retrospective analysis. To investigate the urodynamic effects of solifenacin treatment for neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI). Paraplegic center in Switzerland. Retrospective analysis of case histories and urodynamic data of 35 SCI patients receiving solifenacin for treatment of NDO between 2008 and 2012. Patients were categorized as being at risk of renal damage when maximum detrusor pressure was >40 cm H2O or detrusor compliance was <20 ml cm(-1) H2O. Solifenacin treatment was initiated 7.3 years after SCI. Most patients (63%) had already been taking other antimuscarinic drugs. After 13.1 months (median, interquartile range 6.1-19.5 months), solifenacin treatment had resulted in significant (P<0.03) improvements in bladder capacity (median +30.0 ml), maximum detrusor pressure (median -7.0 cm H2O), reflex volume (median +62.5 ml) and detrusor compliance (median +25.0 ml cm(-1) H2O). Furthermore, fewer patients presented with a risk of renal damage. However, this difference was not significant (P>0.1). The number of patients suffering from incontinence had not changed significantly. Eight and two patients discontinued solifenacin treatment as a result of insufficient efficacy and intolerable adverse events, respectively. One patient had discontinued solifenacin treatment without further explanation. Solifenacin treatment significantly improved bladder capacity, detrusor compliance, reflex volume and maximum detrusor pressure. Solifenacin treatment seems to be an effective oral treatment of NDO after SCI.

Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study

This was a multicentre, prospective, randomised study. To compare the outcomes of intradetrusor and suburothelial onabotulinumtoxinA injections in patients with spinal cord injury and refractory neurogenic detrusor overactivity (NDO). Urology departments of two tertiary hospitals in the Czech Republic. A total of 32 spinal cord injury patients with severe NDO refractory to the standard anticholinergic treatment were randomised to receive either intradetrusor or suburothelial 300 IU onabotulinumtoxinA injections. Subjective satisfaction, bladder diary data and urodynamic data were compared in both groups before treatment and at 3 months post treatment. In all, 64.3% patients in the intradetrusor group and 88.8% patients in the suburothelial group were subjectively satisfied with the treatment. There was a significant post-treatment improvement in both groups regarding the number of catheterisations over 24 h, number of incontinence episodes over 24 h, catheterised volume, cystometric capacity, volume at first involuntary detrusor contraction, maximal detrusor pressure during filling and detrusor compliance. No significant differences between the groups were observed, with the exception of improvement of detrusor compliance, which was better in the intradetrusor group. There was one adverse effect comprising transient muscle weakness that was reported by one patient in the intradetrusor group. Results in both groups were comparable. The authors favour suburothelial onabotulinumtoxinA injection because this method allows more precise toxin localisation.

Voiding dysfunction after repair of giant trigonal vesicovaginal or urethrovesicovaginal fistulae: A need for long-term follow-up

Introduction:Urodynamic findings of lower urinary tract of women presenting with voiding dysfunction after successful repair of complex trigonal vesicovaginal fistulas at our institute are presented.Materials and Methods:In this retrospective case series, women presenting with voiding dysfunction after successful repair of obstetric fistulae were evaluated. In addition of standard clinical evaluation with history and clinical examination, all underwent kidney-ureter-bladder ultrasonography, renal function test, urine culture, and multichannel urodynamics. The latter consisted of free uroflowmetry, filling and voiding cystometry.Results:Five women (median age 35 years; range 30–45) presented with difficulty in voiding after the successful repair; two presented within 1 year and 3 after 10 years. The latter three presented with bilateral hydroureteronephrosis; one of these had chronic kidney disease (CKD) grade IV at presentation. Urodynamics (UDS) of all patients revealed poor detrusor compliance (median 11 ml/cm H2O; range 5–22), high-end filling detrusor pressures (median 41 cm H2O; range 11–46) and no detrusor overactivity. All patients attempted voiding with abdominal straining; with little contribution of detrusor contraction (median 6 cm H2O; range 0–9). Two patients could not void during the study, one with Tanagho reconstruction and another with CKD.Conclusion:Even after successful repair, patients with complex trigonal or urethra-vesicovaginal fistulae warrant indefinite long-term follow-up for voiding dysfunction in view of possibility of developing poorly compliant bladder.

Long-term follow-up after botulinum toxin A (BTX-A) injection into the detrusor for treatment of neurogenic detrusor hyperactivity in children

PurposeTo prove the long-term efficacy of BTX-A injection in the management of children with neurogenic detrusor hyperactivity.Materials and methods28 out of 145 children with neurogenic bladder (15 male and 13 female, mean age 10.7 years) who were treated between 2002 and 2010 and became non-responders to conservative treatment were included into the retrospective study.We injected 10-12 U/kg of BTX-A (Botox®) into the detrusor at 20-30 sites, sparing the trigone. The mean follow-up was 48 months (range 6-84 months).ResultsGroup 1. 14 patients had a single injection of BTX-A. Five of them were successful.Mean bladder reflex volume increased (from 62.9 to 117.5 ml), maximum detrusor pressure decreased (from 59 to 37.5 cm H2O), detrusor compliance increased (from 4.8 to 9.5 ml/cm H2O), and leak-point-pressure decreased (from 46.5 to 24.2 cm H2O). Four patients did not respond and were treated by ileocystoplasty. Another five were lost to follow-up. Group 2. 14 patients had repeated (mean 2.5) injections of BTX-A with a mean interval of 13.7 months. In thirteen patients, urodynamic parameters of the first and last injection were similar to those obtained in Group 1, showing a good response. One patient received an ileocystoplasty.ConclusionBTX-A is a safe alternative in the treatment of detrusor hyperactivity in children with myelomeningocele (MMC). The efficacy lasted a mean of 12 months and urodynamic response was unchanged even after several injections. In our series, 21.7% of children with severe low-compliance bladders were non-responders.

1517 EFFICACY OF ONABOTULINUMTOXINA IN PATIENTS WITH NEUROGENIC BLADDER AND DECREASED BLADDER COMPLIANCE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20111517 EFFICACY OF ONABOTULINUMTOXINA IN PATIENTS WITH NEUROGENIC BLADDER AND DECREASED BLADDER COMPLIANCE Laura Mengheang, John Hairston, and Christopher Smith Laura MengheangLaura Mengheang Houston, TX More articles by this author , John HairstonJohn Hairston Chicago, IL More articles by this author , and Christopher SmithChristopher Smith Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1496AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intradetrusor injection of botulinum toxin type A (BoNT-A) has previously been shown to be a safe and efficacious treatment for patients with neurogenic detrusor overactivity and normal bladder compliance. In this study, we examined the efficacy of BoNT-A injection in patients with neurogenic bladder due to spinal cord injury, most of whom had decreased detrusor compliance at baseline. METHODS Data were collected retrospectively from 24 patients with urinary incontinence secondary to spinal cord injury, each of whom underwent intradetrusor injection of 300 units of onabotulinumtoxinA (onaBoNT-A) (except 100 units in one case). Urodynamics were conducted at baseline and at mean of 2.5 months post-injection, and data were analyzed by paired t-test. Normal compliance was defined as >20 ml/cm H2O. Favorable clinical response was defined as decrease in frequency of catheterization and/or absence of incontinence episodes. RESULTS Eighteen of 24 patients (75%) reported a favorable clinical response. Overall, there was a significant improvement in urodynamic parameters after onaBoNT-A injection. Seventeen of the 22 patients who had decreased baseline compliance had improvement of compliance, 12 of whom had improvement into the normal range after onaBoNT-A injection (baseline 11.2 + 1 ml/cm H2O, post-treatment 29.2 + 5 ml/cm H2O). Eleven of these 12 patients (92%) also had a favorable clinical response. Furthermore, eighteen of the 24 patients had an elevated maximum detrusor pressure (> 40 cm H2O) with improvement of maximum pressure below 40 cm H2O after onaBoNT-A in 9/18, all of whom had good clinical response. CONCLUSIONS In patients with neurogenic bladder and impaired baseline compliance, intradetrusor onaBoNT-A injections can improve bladder compliance into the normal range (>20 ml/cm). OnaBoNT-A also had a similar effect on reducing maximum detrusor pressure in these patients. This is the largest study to date examining the efficacy of intradetrusor onaBoNT-A injection in patients with neurogenic bladder and decreased compliance. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e608 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Mengheang Houston, TX More articles by this author John Hairston Chicago, IL More articles by this author Christopher Smith Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

818 NOCTURNAL BLADDER EMPTYING: IT PROTECTS NOT ONLY THE UPPER TRACTS OF PATIENTS WITH HIGH PRESSURE BLADDERS, BUT ALSO IMPROVES BLADDER DYNAMICS AS WELL

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfunction, Enuresis1 Apr 2011818 NOCTURNAL BLADDER EMPTYING: IT PROTECTS NOT ONLY THE UPPER TRACTS OF PATIENTS WITH HIGH PRESSURE BLADDERS, BUT ALSO IMPROVES BLADDER DYNAMICS AS WELL Shannon N. Nees, Andrew J. Combs, and Kenneth I. Glassberg Shannon N. NeesShannon N. Nees New York, NY More articles by this author , Andrew J. CombsAndrew J. Combs New York, NY More articles by this author , and Kenneth I. GlassbergKenneth I. Glassberg New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.637AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since first reported by Koff et al in 2002, nocturnal bladder emptying (NBE) has been increasingly recognized as beneficial in protecting the upper tracts of patients with high urine output and defective, poorly compliant bladders. While subsequent reports have documented improvement in renal function and hydronephrosis in these patients, none has documented what urodynamic changes, if any, occur in these bladders as a result of NBE. We report our experience with changes in urodynamic parameters following the addition of NBE to the patient's treatment regimen. METHODS All 15 patients treated with NBE because of persistent abnormal storage pressures despite maximum dose anticholinergic therapy were prospectively assessed urodynamically just prior to and while on NBE. Changes in VUR and hydronephrosis were also assessed. RESULTS Patient demographics and changes in bladder compliance, detrusor storage pressures and detrusor overactivity are reported in Table 1. Bladder compliance improved significantly in 12 (80%), including normalization in 8 (53%); those with HS and PUV had the greatest improvement in compliance on NBE. Detrusor overactivity resolved in 4/7 (57%). Bladder capacity was initially low (<75% expected) in 6 and high (>125%) in 5. On NBE, 9/11 (82%) had normalization of capacity. In patients with available follow up imaging, hydronephrosis improved or resolved in 44%; 2 patients with grades 4 and 5 VUR both decreased to grade 1. When NBE was discontinued by 1 patient he reverted from normal back to severe loss of compliance. CONCLUSIONS Overnight catheter drainage of the bladder not only serves to protect and improve the upper tracts as previously reported but has a direct, beneficial effect on bladder function as well. Patients with impaired detrusor compliance should not be categorized as refractory to non-surgical therapy and in need of bladder augmentation without first having NBE added to their treatment regimen as it has been our experience that the vast majority of patients show dramatic urodynamic improvement on NBE irrespective of the underlying pathology. What is not clear is how long these patients will need to be on NBE nor the long term implications of such management. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e329 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shannon N. Nees New York, NY More articles by this author Andrew J. Combs New York, NY More articles by this author Kenneth I. Glassberg New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Injection of botulinum toxin (BTX-A) in children with bladder dysfunction due to detrusor overactivity

IntroductionBladder dysfunction causes urinary incontinence and kidney damage in children. When treatment with anticholinergics and intermittent bladder catheterization fails, the alternative therapy is bladder augmentation. Patients and methodsBetween 2005 and 2009, a prospective study was carried out with Botox® injected into the detrusor of children suffering from high-pressure bladder despite anticholinergic treatment. We assessed their urodynamic, clinical and radiological evolution prior to and at 4 weeks, 6 months and 1 year after the injection (10u/kg of weight up to 300u). Reinjection was indicated in the event of clinical or urodynamic worsening. We employed the Wilcoxon test to statistically analyze the urodynamic parameters. Results12 patients were treated, 11 with neurogenic bladder (91.7%) and 1 with posterior urethral valves (8.4%). The mean age was 12.6 (4.3–17.8) years and follow-up took place after 40.8 (16.9–45–7) months. Bladder capacity, detrusor compliance and pressure improved after 4 weeks in all the patients except in 2 (16.7%). This improvement decreased after 6 months, although successive injections produced similar changes. One patient (8.3%) received 1 dose, six (50%) two doses and five (41.7%) received three. Clinical and urodynamic improvement in 8 patients (66.7%) prevented bladder augmentation. ConclusionsRepeated botulinum toxin injection in the detrusor is a therapeutic instrument for high pressure and hypocompliant bladders in children. It could replace bladder augmentation in some cases, however further studies with long-term follow-up care are required to appropriately evaluate its safety and effectiveness.

Injections of Botulinum Toxin A into the detrusor to treat neurogenic detrusor overactivity secondary to spinal cord injury

To present a comprehensive experience of botulinum toxin A (BTX-A) injected into the detrusor muscle in patients with spinal cord injuries (SCI) causing neurogenic detrusor overactivity. Three hundred units of BTX-A were injected cystoscopically into the detrusor muscle of 108 patients with neurogenic detrusor overactivity secondary to SCI at 30 different locations. Evaluations were performed before the injections and 6 weeks after, and they included determination of bladder urinary continence status, frequency/volume chart of CIC, concomitant anticholinergic medication use, Incontinence Quality of Life questionnaire (I-QOL) and patient satisfaction. Key urodynamic parameters (reflex volume, maximum detrusor pressure during voiding, detrusor compliance and maximum cystometric capacity) were analyzed at the outset and during the follow-up (6, 12 and 36 weeks) examinations. By the time of the urodynamic follow-up examinations (6, 12 and 36 weeks), the mean cystometric capacity (P < 0.05) and the mean reflex volume (P < 0.05) increased significantly, while the mean voiding pressure (P < 0.05) decreased significantly. No complications or side effects were reported. Most patients considerably reduced or even stopped taking anticholinergic drugs and were satisfied with the treatment. This retrospective study indicates that BTX-A injections into the detrusor muscle to treat neurogenic detrusor overactivity secondary to SCI are safe and valuable. Significant improvement of bladder function corresponded with continence and subjective satisfaction indicated by the treated patients.

The Physiological Significance of p27 KIP1 Expression in Detrusor Function

Bladder outlet obstruction results in smooth muscle cell hyperplasia, decreased bladder wall compliance, and lower and upper urinary tract pathology. The cyclin-dependent kinase inhibitor p27(KIP1) regulates bladder smooth muscle cell proliferation in response to bladder outlet obstruction but little is known about its physiological role in the bladder. We investigated the role of p27(KIP1) in the structure and function of the detrusor layer of the bladder wall. We used immunoblotting and reverse transcriptase-polymerase chain reaction to examine cell cycle regulation in response to increased mechanical tension in an in vitro model of tension induced smooth muscle cell proliferation and an in vivo model of bladder outlet obstruction. We compared unobstructed bladders of p27(+/+) and p27(-/-) mice (Jackson Laboratory, Bar Harbor, Maine) structurally by histological staining and functionally by in vivo cystometric measurements of bladder capacity, detrusor compliance and detrusor leak point pressure. Increased tension decreased p27(KIP1) at the protein level in human bladder smooth muscle cells and in intact murine bladder smooth muscle. p27(-/-) mice had bladder smooth muscle cell hyperplasia even in the absence of bladder outlet obstruction. While p27 loss had little effect on detrusor leak point pressure, p27(-/-) mice had significantly decreased bladder capacity and detrusor compliance. To our knowledge we provide the first report of the in vivo significance of p27(KIP1) in the regulation of detrusor function using a cystometric approach. We identified a role for p27(KIP1) in protecting against dysregulated smooth muscle cell proliferation, bladder capacity and detrusor compliance under normotensive conditions.

Evaluation of video-urodynamic studies before renal transplantation in chronic renal failure patients

To evaluate the role of video-urodynamic examination prior to renal transplantation. Sixty-four kidney transplant recipients were included into the study. All patients underwent video-urodynamic examination and separate uroflowmetry. Results were evaluated based on daily mean amount of urine, duration of chronic renal failure and presence of diabetes mellitus. Thirty-five (54.6%) patients showed video-urodynamic abnormalities. The mean detrusor capacity was 234 ml, the mean detrusor compliance was 17.5 cm H(2)O/ml, the mean maximum detrusor pressure was 61.9 cm H(2)O and the mean Q (max) was 13.8 ml/s in all patients. Vesicoureteral reflux was detected in 15 (23%) patients. The mean detrusor compliance and detrusor capacity significantly decreased as the daily amount of urine decreased and as the duration of chronic renal failure increased. Also, there was no significant relation between presence of diabetes mellitus and detrusor capacity and detrusor compliance. Video-urodynamic studies before renal transplantation provide earlier diagnosis of lower tract abnormalities, which are likely to cause graft dysfunction.

Detrusor Compliance Changes After Bladder Neck Sling Without Augmentation in Children With Neurogenic Urinary Incontinence

We reviewed preoperative, and initial and final postoperative urodynamic testing in consecutive children undergoing bladder neck sling without augmentation for neurogenic urinary incontinence to determine if progressive loss of compliance occurs. We assessed consecutive patients with neurogenic outlet incompetence who underwent 360-degree tight fascial wrap around the bladder neck with appendicovesicostomy but no augmentation. This population comprised all patients undergoing outlet surgery between 2002 and 2007. Inclusion criteria were initial urodynamic test within 1 year postoperatively and final urodynamic test at least 18 months postoperatively. A total of 26 patients met inclusion criteria. Most patients (73%) had an acontractile bladder with detrusor pressures less than 25 cm H(2)O preoperatively. Initial postoperative urodynamic test at a mean of 7 months was most predictive of subsequent urodynamic findings. Eight patients (31%) had increased detrusor pressures and/or uninhibited contractions postoperatively. Six patients increased anticholinergic therapy dose. At a mean of 39 months urodynamic patterns were either stable or improved in all patients. Progressive compliance loss was not observed after bladder neck sling without augmentation. Postoperative increases in detrusor pressure and/or uninhibited contractions within 1 year postoperatively should prompt review of anticholinergic therapy rather than enterocystoplasty.

To clamp or not to clamp? Bladder management by suprapubic catheterization in patients with neurogenic bladder dysfunction

In a small subset of patients with neurogenic lower urinary tract dysfunction, insertion of suprapubic catheters (SPC) cannot be avoided. If SPC has to be utilized, catheter clamping and anticholinergic medication are often recommended, but evidence supporting this view is scarce. We determined the influence of anticholinergic medication and catheter clamping on urodynamic parameters and the status of the urinary tract in patients with chronic suprapubic catheterization. In a retrospective study, the results of urodynamic testing, sonographic evaluations, and urinalyses of 85 patients with chronic (>1 year) suprapubic catheterization due to neurogenic bladder dysfunction were analyzed. The 51 male and 34 female patients (mean age 55 years) were managed with an SPC for 65.3 ± 48.0 months. Forty patients had an SPC for more than 60 months. Comparing the results before SPC insertion with the last follow-up examination, no significant differences in detrusor compliance and maximum detrusor pressure were detected, whereas bladder capacity significantly decreased. In three patients, alterations of the upper urinary tract were found. The results were not significantly different between the patients using anticholinergic medication and/or catheter clamping and those who did not. According to our study, routine use of anticholinergic medication and clamping of catheter does not seem to be necessary to preserve detrusor compliance and renal function in patients with SPC and neurogenic bladder dysfunction.

Association Between T102C Polymorphism of Serotonin 2A Receptor Gene and Urinary Incontinence in Older Women

BackgroundThe bladder's regulatory function is influenced by central serotonergic modulation. T102C polymorphism of the serotonin 2A (5-HT2A) receptor gene is associated with urinary incontinence (UI) that has been reported by...

Treatment of Neurogenic Detrusor Overactivity with Botulinum Toxin A: The First Seven Years

Introduction: This retrospective study describes the results of botulinum toxin A detrusor injections following a fixed protocol in 216 patients with untreatable neurogenic detrusor overactivity and incontinence. A comparison is made between the two preparations currently available, and the efficacy of multiple treatments is studied. Patients and Methods: Botox® 300 MU (mouse units) or Dysport® 750 MU were injected into the detrusor wall in 365 sessions in 216 patients. The average age of the 144 men and 72 women was 32.3 years. Patients were investigated before treatment and at 6 weeks and 6 months after treatment. Maximal detrusor pressure, detrusor compliance, reflex volume and cystometric capacity were recorded. Use of anticholinergics and patient satisfaction were ascertained from questionnaires. Appropriate statistics were applied. Results: All urodynamic parameters improved. The use of anticholinergics decreased substantially. No differences were noted between the two preparations. The incontinence situation improved markedly. The effect of the treatment was noted after about 2 weeks and lasted for about 9 months. Conclusions: Botulinum toxin A treatment in neurogenic detrusor overactivity patients is effective, long-lasting and repeatable. The treatment is minimally invasive and might be considered as an alternative to high-dosage anticholinergic medication.

Long‐term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction

To evaluate the influence of repeated botulinum neurotoxin A (BoNT-A) treatments on detrusor function in patients with neurogenic detrusor overactivity (DOA) due to spinal cord lesions. In a retrospective study, urodynamic evaluations of 27 consecutive patients with neurogenic DOA due to spinal cord lesions who received at least five BoNT-A treatments were analysed. After the first BoNT-A treatment, bladder capacity, reflex volume, continence status and detrusor compliance were significantly improved and maximum detrusor pressure (P(detmax)) was significantly reduced. The mean number of BoNT-A treatments was 7.1. Compared with the results of the first treatment, the incontinence rate (seven patients) and the number of patients with an elevated P(detmax) (five patients) were slightly increased after the final BoNT-A treatment. The long-term success rate was 74%. Every fourth patient needed a major surgical intervention. There was a significant decrease in P(detmax) before BoNT-A treatments, indicating that detrusor contraction strength did not completely recover after treatment. Our study confirmed the long-term efficacy of repeated BoNT-A treatments in patients with neurogenic DOA. However, in long-term follow-up, every fourth patient required surgical interventions. Moreover, our data give the first hint that BoNT-A may lead to impaired detrusor contraction strength, which could influence future treatment options. Prospective studies are necessary to elucidate the impact of repeated BoNT-A treatments on detrusor function and the interactions with future treatment options.

Treatment outcomes and resource use of patients with neurogenic detrusor overactivity receiving botulinum toxin A (BOTOX®) therapy in Germany

To evaluate treatment outcomes and resource consumption of patients with neurogenic detrusor overactivity (NDO) before and after botulinum toxin A (Botox) therapy in Germany. In a multi-center, cross-sectional, retrospective cohort study, data of patients with NDO 12 months before and after the first Botox therapy were analyzed. 214 patients (mean age 38 +/- 14.8 years, 145 male, 69 female) with NDO due to spinal cord injury (81%); myelomeningocele (14%), or Multiple Sclerosis (5%) from seven hospitals were included. Mean interval between treatments was 8 months. Following treatment, mean maximum detrusor pressure, maximum cystometric capacity and detrusor compliance improved significantly. Prior to Botox therapy, 68% reported urinary tract infections (UTI), 63% had incontinence episodes, and 58% used incontinence aids. These numbers decreased significantly (p < 0.05) after treatment to 28, 33, and 28%, respectively. In patients using incontinence aids, mean costs per patient decreased from 2euro to 1euro per day, whereas the mean cost of drugs to treat UTIs per patient decreased from 163euro to 80euro per year, respectively. This is the first study demonstrating the clinical usefulness of Botox therapy in clinical practice. Successful treatment resulted in lower costs for NDO associated morbidity due to less need for incontinence aids and UTI medication.

Comparing two types of botulinum‐A toxin detrusor injections in patients with severe neurogenic detrusor overactivity: a case‐control study

To compare the efficacy of two types of botulinum toxin type A (BTX-A; Dysport, Ipsen Ltd, Slough, UK) or Botox (Allergan Inc., Irvine, CA, USA) and examine the possible dose-effect relation for Dysport in those patients, as multifocal detrusor injections with BTX-A are effective for severe neurogenic detrusor overactivity in adults. This was an open-label, observational case-control study comparing Dysport and Botox, and the dose-effect relation for Dysport. The patients included were treated with either Dysport (cases; 500, 750, or 1000 IU), or with Botox (controls: 300 IU, and exceptionally 200 or 400 IU). The continence volume (primary), mean and maximum catheterized volume, and antimuscarinic use were assessed, and cystometric variables measured were overactivity volume (primary), detrusor compliance, and cystometric capacity. All variables were assessed at baseline, 3 and 9 months after treatment, and results analysed using analysis of variance (paired) t-tests, chi-square tests and regression analysis. There were 28 cases and 28 matched controls; their demographic characteristics, bladder management, and baseline values were comparable between the groups. At 3 months there was a significant improvement in cystometric variables and continence volume in both groups, but in mean catheterized volume and reduced use of antimuscarinics in cases only. At 9 months there was no significant improvement over baseline except for the continence volume in the cases. There were no significant differences in results between the groups except for the continence volume at 3 months (459 mL after Dysport and 396 mL after Botox; P=0.015). There was no dose-related response for Dysport at 3.8 months of follow-up. The interval between injections (9.5, 14.5 and 16.1 months for Dysport 500, 750, and 1000 IU; 10.1 months for Botox) was not significant. There were nine non-responders in the Dysport group and seven in the Botox group; the patient characteristics and baseline data were comparable to those of the responders. There was transient hypoasthenia in one of the responders (750 IU Dysport). A single treatment session with either Dysport or Botox in a setting combined with antimuscarinics might improve the patient's condition for up to a year. There was no clear dose-related effect for Dysport in adults.

Botulinum toxin type A for neurogenic detrusor overactivity due to spinal cord lesions in children: A retrospective study of seven cases

To assess the effectiveness and safety of intradetrusor injections of botulinum toxin type A (BTA) used to treat neurogenic detrusor overactivity in children. We retrospectively reviewed the records of seven children treated at least once (7/7: one injection; 4/7: two and three injections; 2/7: four injections; 1/7: five injections) with intradetrusor BTA injections in 2005-2008, for neurogenic detrusor overactivity with incontinence despite timed bladder catheterizations and anticholinergic agents. Clinical, urodynamic, and imaging study data at baseline were collected. Clinical efficacy criteria were the urinary tract infection (UTI) rate, continence, and need for anticholinergic agents. The following urodynamic data were assessed: maximum catheterized volume without leakage, reflex volume, maximum detrusor pressure, and bladder compliance. Seven children received 18 injections. Social continence was achieved from the first injection. No further recurrent lower UTIs occurred. Maximum catheterized volume and reflex volume increased, and maximum detrusor pressure decreased. Detrusor compliance became interpretable and increased. Grade II right vesicoureteral reflux, present at baseline in one patient, resolved after BTA therapy. UTIs were the only adverse effects. Injection with BTA proved effective and safe in the short term. This may be an alternative to surgery in children with neurogenic detrusor overactivity.

Ten years single surgeon experience with botulinum toxin in the urinary tract; clinical observations and research discovery

This review details a single surgeon's 10-year experience with botulinum toxin (BoNT) for lower urinary tract symptoms (LUTS). Review of author's published clinical and research experience with BoNT in the prostate, bladder and urethral sphincter. Key observations include that an approximate 90% decrease is needed for bladder augmentation and reconstruction. Detrusor compliance and vesicoureteral reflux improved in over 50% of patients. Submucosal and trigone injection had similar efficacy with low rate of retention that can benefit patients with sensory urgency. No case of clinical vesicoureteral reflux has been noted with trigone injection technique. Dose of less than 200 U are clinically beneficial with duration of efficacy increasing with subsequent BoNT injection that may result in improved health economics benefits. Symptom improvement commonly lasts no less than 12 months with prostate injection. Experiment evidences that BoNT blocks sensory neurotransmitter release that has correlated with benefits seen in patients with bladder pain and abacterial prostatitis. Similar efficacy is observed in refractory overactive bladder as with neurogenic and idiopathic detrusor overactivity. BoNT is promising for a variety of LUTS in author's personal experience over the past 10 years with research that advanced our understanding of BoNT mechanisms of action in the sensory nerves and prostate gland. International multicenter randomized trials for bladder and prostate indications are currently ongoing seeking regulatory approval.

Effect of Pelvic Floor Interferential Electrostimulation on Urodynamic Parameters and Incontinency of Children With Myelomeningocele and Detrusor Overactivity

To evaluate safety and efficacy of transcutaneous interferential (IF) electrostimulation on voiding symptoms and urodynamic variables in children with myelomeningocele (MMC)-induced refractory neurogenic detrusor overactivity. Thirty MMC children (18 girls, 12 boys; mean age 5.6 +/- 2.7) with moderate to severe intractable incontinency, detrusor overactivity, and high maximal detrusor end-fill pressure were enrolled and then randomly allocated to treatment (IF stimulation, 20 children) and control (sham stimulation, 10 children) groups. They underwent urodynamic study (UDS) before and after IF and 6 months later, with attention to mean maximal detrusor pressure (MMDP), maximum bladder capacity (MBC), mean detrusor compliance (MDC), postvoiding residue (PVR), and detrusor sphincter dyssynergia (DSD). Daily incontinence score, voiding frequency, and enuresis were also assessed. Eighteen courses of pelvic floor IF electrostimulation for 20 minutes 3 times per week were performed with low-frequency current, duration of 250 microseconds, and repetition time of 6.6 seconds. Of the UDS parameters in the treatment group immediately after IF implication, MMDP, PVR, and DSD significantly improved compared with sham stimulation and pretreatment measures (P < .05). In the treatment group, 78% patients gained continence immediately after IF therapy and 60% had persistent continence for 6 months (P < .05). Immediately after IF treatment, urinary frequency and enuresis also improved (P < .05), with a statistically significant difference between the 2 groups. This study demonstrated that noninvasive IF therapy is effective in improving voiding symptoms including incontinence and UDS parameters of MMC children with neurogenic detrusor overactivity. The clinical beneficial implication of this modality is yet to be determined in larger studies.