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| |  Botulinum Toxin Treatment for Overactive Bladder Safe, Effective After 8 Years: Presented at EAU By Jenny Powers BARCELONA, Spain -- April 21, 2010 -- Long-term pharmacological treatment of severe overactive bladder (OAB) and detrusor overactivity with botulinum-A toxin (BoNT-A) injections is efficient and safe, according to a study presented here at the 25th Annual European Association of Urology (EAU) Congress. Daniel Max Schmid, MD, Department of Urology, University Hospital Zurich, Zurich, Switzerland, reported the results of an 8-year follow-up on April 17. The prospective study aimed to evaluate the efficacy and long-term results of low-dose BoNT-A injections into the detrusor muscle for the treatment of severe, non-neurogenic OAB. The study enrolled 240 patients who were injected with BoNT-A 100 U, after recoding of their micturition diary, urodynamics, and neurological status. Clinical and urodynamic checks and quality-of-life (QOL) assessment were performed at baseline and 12 weeks after BoNT-A treatment. The follow-up evaluations included duration of effect, reinjection rate, and intervals between treatments. Within 2 weeks, 84% of patients experienced significant (P < .001) improvement of their bladder function, both in symptoms and urodynamic parameters. Seventy-five percent of the patients reported that urgency completely disappeared, and 85% reported that incontinence was no longer a problem; pad usage dropped from 5.0 to 0.5 pads per day. Frequency of micturitions and nocturia decreased by 50% (from 15 to 7 and 5.0 to 2.5, respectively). Maximum cystometric capacity increased from 235 to 390 mL (+63%), bladder capacity from 21 to 45 mL/cm H2O, and first desire to void from 120 to 212 mL. Efficacy lasted a mean of 8 (+-2) months in all patients. No further therapy was required by 30% of patients; however, 16 patients reported poor clinical benefit. Several patients needed additional treatment; 27.5% (n = 66) required an additional injection, with a mean interval between treatments of 13 months (range 2-50 months). Fifteen patients received a third BoNT-A injection, which had a longer-lasting effect (5.5 months longer between the second and third treatments than between the first and second injections). Nine patients received a fourth injection, and 1 has received 7 injections; urodynamic changes and clinical efficacy in these patients were similar to the first treatment. Side effects included 7 temporary urine retentions and 20 urinary infections. No severe adverse events were reported. The QOL assessment showed a significant subjective improvement in all urge-related items. No deterioration of bladder function was observed even after repeated injections. Dr. Schmid concluded that BoNT-A injections into the detrusor muscle are a safe long-term treatment for patients with severe OAB for at least 8.5 years. Also, although some patients may require subsequent injections to maintain symptom-free status, the period of effectiveness lengthens with repeated injections, and the muscle and bladder are not damaged with repeated treatments. [Presentation title: The Zurich Experiences Including 8 Year Results of 240 Cases Treated With Botulinum-A Toxin Injections Into the Detrusor Muscle for Overactive Bladder Refractory to Anticholinergics. Abstract 93]
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