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Article Type

Original Study

Abstract

Introduction There are many theories behind the etiology of refractory idiopathic detrusor overactivity (IDO), but it is generally accepted that it is caused by a combination of myogenic and neurogenic alterations. It is also believed that mucosal sensory systems make a significant contribution to the disorder as well. Intravesical botulinum toxin A (BoNT/A) prevents acetylcholine release at the neuromuscular junction, resulting in temporary chemodenervation and muscle relaxation. The aim of this work was to assessment of outcome of BoNT/A injection for the treatment of refractory IDO. Patients and methods The author included 37 patients who received intravesical BoNT/A for the treatment of refractory IDO. Of these patients, 25 had 3 years of follow-up. All patients were resistant to oral antimuscarinic therapy and/or adrenergic β3 agonists. BoNT/A was injected intra-detrusor muscle supratrigonally in aliquots of 1 ml delivering 10 units at each injection site, usually at 20 sites. Results A total of 37 patients with urgency and urge incontinent were included; of them, 22 patients had urgency incontinence and 15 patients had severe urgency without incontinence. Significant decreases in urgency incontinence episodes with BoNT/A were seen as early as week 2 (P < 0.001) and continued through week 12 (P < 0.001). Reduction in incontinence episodes was 4–8, which changed to 2–5 after injection. Moreover, 100% reduction in incontinence episodes was minimal and occurred only in 10%. Conclusion BoNT/A promotes significant improvement of urinary urgency, urinary frequency, nocturia, and incontinence symptoms. Although there is incidence of complications especially urinary retention and urinary tract infection among patients, BONT/A still is safe and tolerable.

Keywords

Detrusor overactivity, onabotulinumtoxin A, overactive bladder, urgency incontinence, urgency

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