Intradetrusor Botulinum Toxin Research Articles

Long-term follow-up of intradetrusor botulinum toxin utilisation: A comparison of patients with multiple sclerosis and idiopathic overactive bladder.

To assess long-term outcomes (up to 10cycles) of repeated intradetrusor botulinum toxin (BoNT) utilisation in multiple sclerosis (MS) and idiopathic overactive bladder (OAB). This is a retrospective, international, multi-centre, observational cohort study of patients diagnosed with MS and neurogenic OAB and treated with intradetrusor BoNT between January 2005 and January 2020 (just prior to COVID-19 interruption). Dose, efficacy, duration of effect, International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and International Consultation on Incontinence Questionnaire Urinary Incontinence (ICIQ-UI) measures and complication rates were recorded. Comparisons were made to those with idiopathic OAB. Seven hundred and ninety-two patients received intradetrusor BoNT treatment (104 had MS with neurogenic OAB and 688 had idiopathic OAB). Patients with MS were more likely to receive higher doses of BoNT in all cycles. Self-reported efficacy ranged from 85.7 to 100% (MS) and 87.2 to 100% (idiopathic) with MS patients reporting increased efficacy in cycles 1-3 comparatively (p < 0.05). Duration of effect ranged from 4.5 to 9months with a reduction in the MS cohort between cycles 1 and 10 (median 8months vs. 5months, p = 0.0156). Patients with MS and neurogenic OAB have a good therapeutic effect from intradetrusor BoNT that is sustained over at least 10cycles with significant reduction in the duration of action with subsequent cycles.

INTEGRATING A VIRTUAL REALITY MASK IN FUNCTIONAL UROLOGICAL SURGERIES UNDER LOCAL ANESTHESIA: A PROSPECTIVE COHORT STUDY ON UTILITY AND SATISFACTION

OBJECTIVESTo evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol. METHODSThis is a single-centre prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VRTM virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, two questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient’s reported intraoperative pain and anxiety. RESULTSThirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (p=0.01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (p=0.12), respectively. Preoperative and postoperative STAI index were 34.8+-10 and 32.8+-10.3 (p=0.88). Mean Likert anxiety scale value was 2.2+-1.1, mean intraoperative VAS score was 5.3+-2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative. CONCLUSIONSVirtual reality mask may play a role in reducing pain and anxiety in minimally-invasive functional urological interventions.

THE EFFECT OF THE FIRST INTRADETRUSOR BOTULINUM TOXIN INJECTION ON FUNCTIONAL INDEPENDENCE, QUALITY OF LIFE, PAIN AND SPASMS IN INDIVIDUALS WITH SPINAL CORD INJURY

After a spinal cord injury (SCI) practically all patients experience neurogenic bladder dysfunction. The botulinum toxin type A is a procedure for treating urological complications in these patients. The objective this study was to analyze whether individuals with traumatic SCI have improved functionality, quality of life (QoL), pain, and spasms after the first application of intradetrusor botulinum toxin type A. A prospective longitudinal observational study was developed with twenty patients with traumatic SCI followed up in a rehabilitation center. The patients were evaluated before, one and four months after the first application of intradetrusor botulinum toxin type A. The instruments used were: Spinal Cord Independence Measure III (SCIM III) and Qualiveen-SF, to assess functionality and QoL, respectively; Numeric Rating Scale for pain assessment and the Penn Scale to assess the spasms. Descriptive and inferential (p &lt;0.05) statistics were perfomed. Of the patients evaluated, 90% were men, and 80% had paraplegia. In the first month after applying botulinum toxin type A, there was improvement in the domain related to sphincter control of SCIM III (p=0.02). There was no statistically significant difference in the QoL, pain intensity, frequency and severity of spasms before application of botulinum toxin and after 1 and 4 months (p&gt;0.05). The first application of intradetrusor botulinum toxin type A interfered positively functional independence related to sphincter control in the first month after application, but did not influence the pain, spasm and QoL.

Real-World Use of Intradetrusor Botulinum Toxin Injections: A Population-Based Study from France.

In recent decades, intradetrusor injections of botulinum toxin A (BoNT-A) have been widely applied to treat incontinence in both idiopathic overactive bladder (iOAB) and neurogenic detrusor overactivity incontinence (NDOI). This analysis, based on the French National Hospital Discharge Database (PMSI), aims to describe real-world trends in intradetrusor BoNT-A use between 2014 and 2022. Among 32,864 patients who received at least one intradetrusor BoNT-A injection, 18,320 (55.7%) had conditions coded under iOAB, 13,376 (40.7%) under NDOI, and 1168 (3.6%) under other indications. The overall mean interval between two intradetrusor BoNT-A injections was 9.7 months, ranging from 8.7 months in patients with multiple sclerosis (MS) to 11.5 months in patients with cerebral pathologies. The median number of injections was two (quartile 1-quartile 3, 1-4) in patients with spina bifida, whereas it was five (2-10) in those with MS. Only 31% of patients with iOAB received more than two intradetrusor BoNT-A injections. Regardless of its indication, BoNT-A was well tolerated. Adverse events occurring during or requiring hospitalization included infections (3.8%), hematuria (0.53%), and bleeding episodes necessitating transfusions (0.11%), all recorded within the initial month following BoNT-A injection. Our analysis of the PMSI database highlights a broad spectrum of intradetrusor BoNT-A injection practices.

Comparison of quality of life after bladder augmentation in patients previously treated with intradetrusor botulinum toxin A for neurogenic detrusor overactivity

PurposeTo compare the quality of life (QoL) in the same patients first treated with botulinum toxin A (BTA) injections for neurogenic detrusor overactivity (NDO) and then with bladder augmentation (BA). MethodRetrospective study of patients who had BA after BTA treatment between January 2012 and December 2022. Qualiveen Short Form questionnaires and a 7-level Likert/PGI-I scale to answer the question “How would you describe your quality of life after surgery compared to when you felt your best with BTA injections?” were collated and analyzed. ResultsFifty-two BAs for neurogenic bladder (NDO or low compliance) were performed in patients with a median age of 43years [33; 52] previously treated with BTA. After a median follow-up of 33.5 [13.8; 54.3] months, the median Qualiveen-SF global score after BA was significantly higher than that obtained at best BTA efficacy (1.63 [1; 2.63] vs. 2.63 [1.88; 3], P=0.012), as were the scores for the fear, constraints/restrictions and limitations/inconvenience domains. The median PGI-I score was +3 [2; 3] (truly better QoL) and 85.4% of patients reported a QoL after BA superior to the best QoL under BTA. ConclusionBA provides a greater range of QoL improvement than BTA injection for patients who have experienced both treatments. Long-lasting effects and absence of need to perform iterative retreatment were the main reasons. Level of evidence4.

Intradetrusor botox injection and augmentation cystoplasty trends among spina bifida patients at US freestanding children's hospitals

Intra-detrusor botulinum toxin (Botox) injection is a minimally invasive alternative to augmentation cystoplasty in patients with refractory neurogenic bladder. Botox was first used for neurogenic bladder children two decades ago. However, there are no existing guidelines on indications or use among patients with spina bifida. Furthermore, there are little data regarding its use relative to bladder augmentation and patient volume on a national scale. We sought to investigate the contemporary trends of intra-detrusor Botox injection and augment cystoplasty in free-standing children's hospitals. We queried the Pediatric Health Information System database to identify spina bifida patients from 2016 to 2019 who underwent intra-detrusor Botox injection and augment cystoplasty based on CPT and ICD-10 codes. Total spina bifida population under care in the free-standing children's hospitals was estimated by all inpatient and ambulatory surgery encounters as denominators to calculate frequency by time for both intra-detrusor Botox injections and augmentation cystoplasty. In total, we included 1924 intra-detrusor Botox injections and 842 augmentation cystoplasties. 1413 (51.1%) patients were female. Median age at surgery was 10.0 (interquartile range 6.98-13.5) years. There was a significant increase in intra-detrusor Botox injection frequency (p<0.001). While there was an overall decreasing, but not significant, trend for augmentation cystoplasty, there was a significant increase in this procedure during the summer months compared to the rest of the year (p<0.001, Figure1). Sensitivity analysis using only first intra-detrusor Botox injection per patient demonstrated similarly significant increasing trend. Use of intra-detrusor Botox injection for the management of neurogenic bladder has significantly increased among patients with spina bifida while augmentation cystoplasty has slightly decreased, but not significantly. Over time, practice patterns for the treatments of neurogenic bladder among spina bifida children have favored minimally invasive Botox injections while augmentation cystoplasty use has not significantly changed.

The Efficacy and Safety of Intradetrusor Botulinum Toxin Injection in Urinary Incontinence in Geriatric Patients

The Efficacy and Safety of Intradetrusor Botulinum Toxin Injection in Urinary Incontinence in Geriatric Patients

Bladder augmentation in the era of botulinum toxin: Indications and results

To determine the surgical indication and results of bladder augmentation (BA) during the last decade in a neurourology center in the era of intradetrusor botulinum toxin injection. We conducted a retrospective study that included patients with BA between January 1, 2012 and December 31, 2022 in our centre. We collected pre-operative demographic, clinical, and urodynamic data, BA indication, and associated procedures. We analyzed early and late complications as well as continence and postoperative voiding mode in patients with first BA in a neurological pathology context. We performed 77 BA over the study period. The main indication was neurogenic overactive bladder, which was secondarily resistant to botulinum toxin. The main associated procedure was continent cutaneous diversion (n=31, 57.4%). Among patients who had a first BA for neurogenic bladder, 34 patients had early complications (50%) including 12 patients with≥Clavien 3 complications (17.6%). After a median follow-up of 33 [14; 55] months, 23 patients had late complications (33.8%) and 59 patients had complete continence (86.8%). In the era of botulinum toxin, the main indication of BA is the secondary failure of botulinum toxin for overactive neurogenic bladder. The BA provided continence in 86.8% of patients. It remains however an intervention with a significant rate of severe complications whose indication must be discussed by a multidisciplinary team. Weak.

Long-term beneficial effects of mirabegron in pediatric patients with therapy-refractory neurogenic lower urinary tract dysfunction

Neurogenic lower urinary tract dysfunction (NLUTD) in children can cause renal failure and urinary incontinence if not treated sufficiently. Antimuscarinics (AM) and intradetrusor botulinum toxin injections (BoNT-A) with clean intermittent catheterization (CIC) are widely used treatment options for children with NLUTD. However, a considerable number will become refractory to these treatment options. This study aimed to evaluate the efficacy and long-term outcomes of mirabegron in children with NLUTD as an add-on and as a stand-alone treatment. Patients under 18 years of age with NLUTD who were refractory to AM and/or BoNT-A and were treated with mirabegron 50mg were retrospectively studied. Mirabegron was either used as monotherapy or in addition to AM and/or BoNT-A. Video-urodynamic studies (VUDSs) were performed before and after treatment with mirabegron. Changes in video-urodynamic parameters, the need for other NLUTD therapy during follow-up, patient-reported side effects, and urinary incontinence were outcomes of interest. A total of 34 patients with NLUTD were included. All patients were on CIC and the median age was 13.1 years (IQR 15.9-10.3). Median follow-up was 31.4 months (IQR 57.4-11.4). Bladder compliance improved by 89.9%, from 14.9 to 28.3ml/cm H2O (p-value<0.001). Maximum cystometric capacity, end-filling detrusor pressure, volume at first detrusor overactivity, vesicoureteral reflux, and urinary incontinence significantly improved after mirabegron. The add-on therapy group showed more significant improvements in video-urodynamic outcomes compared to the monotherapy group. The median time of requiring other NLUTD therapy was 25.5 months (IQR 39.8-14.8). None of the included patients reported side effects. Mirabegron is an effective treatment for children with therapy-refractory NLUTD with an average efficacy of 2 years after which additional therapy is required. Despite the retrospective character of this study, our results confirm the beneficial effect of mirabegron in children with therapy-refractory NLUTD, in particular when mirabegron is used as add-on therapy in those with low-compliance bladders.

Application of urethral injection of calcium hydroxyapatite as a natural bulking agent for improvement of urinary incontinence in children with spinal dysraphism

The aim of this report is to evaluate the efficacy of endoscopic injection of calcium hydroxyapatite (CaHA) into the bladder neck and posterior urethra in children with refractory urinary incontinence due to spinal dysraphism. A retrospective study was performed on patients with neuropathic bladder due to spinal dysraphism who had undergone submucosal urethral injections of CaHA from 2010 until 2019. All patients were totally incontinent without voiding per urethra and did not respond to 1-year standard pharmacotherapy with anticholinergic drugs. All children underwent a precise physical exam and urodynamic studies. Patients underwent urethrocystoscopy and injection of pure soluble CaHA into the bladder neck and posterior urethra except for the verumontanum. The outcomes were determined as no change, improvement (social continent), or cure (total continent). Fifteen children (ten boys, five girls, mean age of 7.6years) with a history of spinal dysraphism and refractory urinary incontinence were included. Endoscopic injections of CaHA were performed one or two times for each patient. At the median follow-up of 2years (interquartile range = 6), seven (46.7%), three (20.0%), and five (33.3%) of the patients were total continent, social continent, and total incontinent, respectively. In four patients, intradetrusor botulinum toxin injection was performed simultaneously with CaHA injection. Also, one patient experienced a febrile urinary tract infection between two CaHA injections. Among 15 patients, 9 had atonic/hypotonic bladders both before and after CaHA injections; at the last follow-up, 4 of these children (44.4%) were totally continent. No injection-related or other complications were observed in the patients. Injection of CaHA into the bladder neck is relatively safe, reproducible, and effective for total dribbling urinary incontinence in children with spinal dysraphism. The bladder neck reconstruction with or without a urethral sling or other surgical procedures could be postponed until puberty in selected cases. However, further multicenter clinical trials are highly recommended.

Clinical Guidelines of Patient-Centered Bladder Management of Neurogenic Lower Urinary Tract Dysfunction due to Chronic Spinal Cord Injury - Part 2

Bladder management of chronic spinal cord injured (SCI) patients usually starts with conservative treatment or minimally invasive procedures. This article reports the current evidence and expert opinions on the patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among patients with chronic SCI in Taiwan. We evaluated the role of clean intermittent catheterization (CIC), cystostomy, medical treatment, and minimally invasive therapy for treating urinary incontinence and voiding dysfunction in patients with chronic SCI. The bladder management for chronic SCI patients should be individualized. A balance between upper urinary tract protection and life quality improvement should be considered. Hand dexterity, abdominal muscle power, bladder sensation, and degree of urethral sphincter dyssynergia might affect the improvement of voiding efficiency and NLUTD. Intradetrusor Botulinum Toxin Type A (BoNT-A) injection has been proven to effectively treat neurogenic detrusor overactivity in SCI patients. However, CIC is still required in some patients after treatment. The urethral sphincter BoNT-ABoNT-A injection can effectively relax the dyssynergic sphincter; however, exacerbation of urinary incontinence usually limits its application in SCI patients. Repeat BoNT-ABoNT-A injection is necessary to maintain the therapeutic efficacy; therefore, some SCI patients might discontinue the treatment and convert to a permanent bladder management by surgical intervention. Identification of high-risk SCI patients is important to prevent renal functional deterioration in those with chronic SCI-NLUTD. Avoiding renal function deterioration and improving the quality of life of SCI patients with NLUTD are the most important aspects of treatment. Annual active surveillance of bladder and renal function is necessary.

PD34-05 DOES COGNITIVE IMPAIRMENT IMPACT SACRAL NEUROMODULATION IN OLDER PATIENTS WITH OVERACTIVE BLADDER?

You have accessJournal of UrologyCME1 May 2022PD34-05 DOES COGNITIVE IMPAIRMENT IMPACT SACRAL NEUROMODULATION IN OLDER PATIENTS WITH OVERACTIVE BLADDER? Jacqueline Zillioux, Kevin Lewis, Daniel Hettel, Sarah Martin, Lauren Gleich, Howard B. Goldman, and Bradley Gill Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Kevin LewisKevin Lewis More articles by this author , Daniel HettelDaniel Hettel More articles by this author , Sarah MartinSarah Martin More articles by this author , Lauren GleichLauren Gleich More articles by this author , Howard B. GoldmanHoward B. Goldman More articles by this author , and Bradley GillBradley Gill More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002585.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) and cognitive impairment (CI) are both increasingly prevalent with age. Given the association between anticholinergics and dementia, there is need to optimize other therapies. Though AUA/SUFU OAB guidelines cite intact cognitive ability as necessary to maintain sacral neuromodulation (SNM), the impact of cognitive function on SNM outcomes remains unknown. This study assessed the impact of CI diagnosis on SNM in older patients. METHODS: A retrospective review was completed of patients ≥55 years old who underwent test-phase SNM (peripheral nerve evaluation (PNE) or stage 1) for urge-frequency or urgency urinary incontinence between 1/2014-3/2021 within a large regional health system. Patient demographics, comorbidities, CI diagnoses (dementia or mild CI), OAB medication and/or botulinum toxin use, and SNM procedures were recorded. SNM procedures and outcomes were categorized as implant, explant, and/or revision. Uni- and multivariable logistic regression modeling assessed for the impact of CI on implantation rates. RESULTS: A total of 510 patients underwent SNM test-phase (161 PNE, 349 Stage 1). Mean age was 71.0 (8.5) years and the majority (79.6%) were female. Overall, 52 (10.1%) patients had a CI diagnosis at the time of SNM, and 30 (6.0%) were diagnosed after SNM at a median 18.5 [9.25, 39.5] months. Patients with CI were older with more comorbidities and were more likely to undergo PNE (Table 1). Univariable analysis found no difference in implantation rate based on pre-SNM CI (85.4% vs 76.9%, p=0.16). Multivariable modeling identified PNE (OR 0.42, 95%CI 0.26-0.70) and age (OR 0.95, 95%CI 0.93-0.98), but not CI or dementia, as independent negative predictors of implantation. Implanted patients had median follow-up of 12 [4.0, 39.5] months. Patients with CI were more likely to continue B3 agonists (37.1% vs 16.0%, p=0.04) following implant but rates of anticholinergic or new intradetrusor botulinum toxin use did not differ. Explant (12.1%), revision (10.4%), and battery replacement (3.4%) rates also did not differ according to CI. CONCLUSIONS: Patients with CI and OAB proceed to SNM implant at rates that do not differ from patients without cognitive deficits. CI should not preclude providers from offering SNM for refractory OAB. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e561 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacqueline Zillioux More articles by this author Kevin Lewis More articles by this author Daniel Hettel More articles by this author Sarah Martin More articles by this author Lauren Gleich More articles by this author Howard B. Goldman More articles by this author Bradley Gill More articles by this author Expand All Advertisement PDF DownloadLoading ...

Perspectives on the urological care in Parkinson's disease patients.

Parkinson's disease (PD) is recognized as the most common neurodegenerative disorder after Alzheimer's disease. Lower urinary tract symptoms are common in patients with PD, either storage symptoms (overactive bladder symptoms or OAB) or voiding symptoms. The most important diagnostic clues for urinary disturbances are provided by the patient's medical history. Urodynamic evaluation allows the determination of the underlying bladder disorder and may help in the treatment selection. Pharmacologic interventions especially anticholinergic medications are the first-line option for treating OAB in patients with PD. However, it is important to balance the therapeutic benefits of these drugs with their potential adverse effects. Intra-detrusor Botulinum toxin injections, electrical stimulation were also used to treat OAB in those patients with variable efficacy. Mirabegron is a β3-agonist that can also be used for OAB with superior tolerability to anticholinergics. Desmopressin is effective for the management of nocturnal polyuria which has been reported to be common in PD. Deep brain stimulation (DBS) surgery is effective in improving urinary functions in PD patients. Sexual dysfunction is also common in PD. Phosphodiesterase type 5 inhibitors are first-line therapies for PD-associated erectile dysfunction (ED). Treatment with apomorphine sublingually is another therapeutic option for PD patients with ED. Pathologic hypersexuality has occasionally been reported in patients with PD, linked to dopaminergic agonists. The first step of treatment of hypersexuality consists of reducing the dose of dopaminergic medication. This review summarizes the epidemiology, pathogenesis, risk factors, genetic, clinical manifestations, diagnostic test, and management of PD. Lastly, the urologic outcomes and therapies are reviewed.

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder.

PurposeIntradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB.Patients and MethodsThis retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients’ outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident.ResultsTwenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2–2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability.ConclusionIntradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.

Distinguishing Features of the Urinary Bacterial Microbiome in Patients with Neurogenic Lower Urinary Tract Dysfunction.

We aimed to characterize the urinary microbiome of catheterizing patients with neurogenic lower urinary tract dysfunction (NLUTD) and to evaluate differences based on type of bladder management or frequency of urinary tract infections. This is a prospective, cross-sectional study of urine samples from asymptomatic, catheterizing patients with neurogenic lower urinary tract dysfunction who used either clean intermittent catheterization or indwelling catheters. Patients without symptoms of urinary tract infection provided a catheterized urine sample for urinalysis, culture and bacterial community microbiome analysis. A total of 95 patients submitted urine for analysis, of whom 69 had sufficient sequence reads (>1,203) for microbiome analysis. Cases with low bacterial signal amplification were associated with use of vaginal estrogen, no intradetrusor botulinum toxin A use and no growth on standard urine culture. The most abundant operational taxonomic units were from the phylum Proteobacteria, classified as Enterobacteriaceae and Escherichia. Alpha diversity varied among those who used indwelling catheters vs clean intermittent catheterization, and those who underwent botulinum toxin A injection vs not. On linear discriminate analysis, the relative abundance of the operational taxonomic units identified as Pseudomonas was higher among patients using indwelling catheters relative to clean intermittent catheterization. The operational taxonomic unit identified as Aerococcus was at a higher relative abundance among males compared to females. Enterobacteriaceae and Escherichia were the most abundant genera in the urinary microbiome of patients with neurogenic lower urinary tract dysfunction. Urinary microbiome diversity varied based on bladder management type. Future clinical correlations between microbiome of neurogenic patients and clinical presentation may help guide treatment strategies.

Efficacy and safety of intradetrusor botulinum toxin injections for idiopathic overactive bladder syndrome in patients with an artificial urinary sphincter.

To assess the efficacy and safety of intradetrusor botulinum toxin type A injections (IBTI) for idiopathic overactive bladder (iOAB) in non-neurological adults with an artificial urinary sphincter (AUS). We retrospectively selected, in the 11 French centers, members of a collaborative network (GENULF (Groupe d'étude de neuro-urologie de langue francaise)), the patients who had had an artificial urinary sphincter implantation and who had subsequently developed iOAB requiring IBTI. This study was approved by the French association of urology ethics committee (no 2018012). Between 2006 and 2020, 33 patients were included from 5 French centers. Mean follow-up after the first IBTI was 47months. The average age of the studied population was 68years, with 70% of females. A complete resolution of symptoms at optimal IBTI dose was experienced by 21 (64%) patients. Seven (21%) patients had partial improvement. Five non-responder patients (15%) had no improvement at all. Maximum cystometric bladder capacity was 240ml pre-IBTI and 335ml post IBTI. Discontinuation free survival at 60months was 50%. Two erosions occurred during the 6months following an IBTI both in male patients with a perineal implantation. There were four AUS balloon perforations that occurred during the 6months following an IBTI, all of them in female patients. IBTI has a good efficacy for the treatment of iOAB in patients with an AUS. However, both patients and practicians must be aware of the risk of rare and usually mild complications.

MP02-20 VARIANCE IN DEFINING RETENTION AFTER ONABOTULINUMTOXINA INJECTION FOR NON-NEUROGENIC OVERACTIVE BLADDER

INTRODUCTION AND OBJECTIVE:Reported rates of retention following intradetrusor botulinum toxin A (BoNT) injection for overactive bladder (OAB) vary widely from 1.6% to over 35%. We conducted a syst...

Botulinum toxin A improves neurogenic bladder fibrosis by suppressing transforming growth factor β1 expression in rats.

BackgroundIntradetrusor botulinum toxin A injection is recommended for the treatment of refractory detrusor overactivity (DO) in patients with neurogenic bladder, however, whether it could inhibit neurogenic bladder fibrosis is uncertain. This study aimed to investigate the effect of botulinum toxin A on neurogenic bladder fibrosis and the underlying mechanism.MethodsForty eight Female Wistar rats were evenly randomized into 4 groups: Sham, T10 transection, Early and Late groups. The last three groups were subjected to T10 spinal cord transection, while the Sham group was treated with sham surgery. 0.9% saline was injected into the detrusor in the Sham and T10 transection groups simultaneously with the surgery, while 2 U/rat botulinum toxin A was injected into the detrusor simultaneously with the surgery in the Early group and 4 weeks following the surgery in the Late group. Body/bladder weight, cystometric parameters, bladder Hematoxylin-eosin staining were used to evaluate the bladder fibrosis. Western blot and quantitative Real-time PCR were used to evaluate the expression of bladder transforming growth factor β1.ResultsCompared with the T10 transection group, the bladder/body weight was decreased significantly in the Early and Late groups (P<0.05), along with the significant inhibition of non-voiding contraction (NVC) frequency and amplitude (P<0.05), and the significant increase of bladder volume (P<0.05). The detrusor connective tissue percentage (P<0.05) and the expression of transforming growth factor β1 (P<0.05) also decreased significantly in the Early and Late groups. Those changes were more obviously in the Early group than in the Late group.ConclusionsIntradetrusor botulinum toxin A injection reduced bladder fibrosis in rats with spinal cord injury (SCI), which was more obviously in the Early group than in the Late group. The mechanisms might be mediated by suppression of transforming growth factor β1 (TGF-β1) expression.

Comparison of intravesical instillation of hyaluronic acid with intradetrusor botulinum toxin A injection or cystoscopic hydrodistention for ketamine-associated cystitis.

ObjectiveThis study aimed to compare the therapeutic effect of intravesical instillation hyaluronic acid with intradetrusor botulinum toxin A (BTX-A) injection or cystoscopic hydrodistention for ketamine-associated cystitis.MethodsThirty-six patients were evenly randomly divided into the BTX-A group or the hydrodistention group. Patients received 200 U BTX-A detrusor injections in the BTX-A group and cystoscopic hydrodistention in the hydrodistention group. Intravesical instillation of hyaluronic acid was administrated in both groups for eight times. Patients with involuntary detrusor contraction were divided into the persistent involuntary detrusor contraction group and resolved involuntary detrusor contraction group after treatment in 6 months. The predictors of persistent involuntary detrusor contraction were analyzed.ResultsTwelve months after treatment, the daytime frequency, Interstitial Cystitis Symptom Index, maximal capacity, and maximal cystometric capacity in the BTX-A group were significantly better than those in the hydrodistention group. Patients with resolution of involuntary detrusor contraction had a significantly shorter duration of ketamine, lower amount of fibrosis in pathology, and higher maximal capacity than those with persistent involuntary detrusor contraction 6 months after therapy.ConclusionIntravesical instillation of hyaluronic acid with intradetrusor BTX-A injection appears to be a preferable option for long-term effectiveness compared with cystoscopic hydrodistention.

A retrospective review of the long term clinical outcomes of patients with neurogenic lower urinary tract dysfunction following transverse myelitis.

Transverse myelitis (TM) is an inflammation of the spinal cord which causes neurological deficit in motor, sensory, and autonomic pathways. Persistent neurogenic lower urinary tract dysfunction (NLUTD) is common even where motor and sensory impairment is recovered. Long term follow-up is required to ensure optimal bladder management and protection of the upper tracts. We describe the clinical outcomes for a cohort of patients with TM who have received neurourological follow-up in a specialist center. A retrospective review of TM patient records was performed. Current pharmaceutical and surgical management, upper tract status, and patient reported symptoms are reported. Changes in urodynamic parameters and bladder emptying technique between current and baseline were analyzed. Sixty patients with NLUTD following TM were identified. The mean age at onset of NLUTD was 29 years (0-77 years). The mean follow-up was 13 years. 55% of patients were taking antimuscarinic medication, 53% of patients had intradetrusor botulinum toxin injections and 5% had bladder augmentation surgery. Forty-one patients had a baseline and recent urodynamic study which could be compared. Fifty-three of fifty-eight patients with a recent renal ultrasound had normal renal appearance. Four had mild hydronephrosis and one more extensive hydronephrosis. TM can have a persistent effect on lower urinary tract function. There is potential for upper tract damage if bladder management is not optimized. We have demonstrated that in a specialist neurourology unit within a tertiary center, one can provide acceptable long term outcomes following international guidelines.