Comparative assessment of the efficacy of onabotulinumtoxinA as monotherapy and combined therapy with propiverine in female refractory overactive-bladder syndrome

Abourjila A. Gamal Eldin, Department of Urology, National Institute of Urology and Nephrology, Cairo, EgyptFollow
Ayman M. Gabr, Department of Urology, National Institute of Urology and Nephrology, Cairo, Egypt
Amr M. Elsofy, Department of Urology, National Institute of Urology and Nephrology, Cairo, Egypt

Article Type

Original Study

Subject Area

Urology

Abstract

Objectives The aim of the study was to compare the efficacy of onabotulinumtoxinA and anticholinergic popeverine in adult females. This is a placebo-controlled study. Introduction The active ingredient, propiverine hydrochloride, blocks muscarinic receptors with a slightly higher affinity for the M3 as compared with the M2 subtype. In addition, it inhibits calcium influx and modulates intracellular calcium in the bladder smooth-muscle cells, which then leads to musculotropic spasmolysis. Patients and methods Between 2015 and 2019, 94 patients received intravesical onabotulinumtoxinA for the treatment of refractory idiopathic detrusor overactivity after its introduction into the Department of Urology of our National Institute of Urology and Nephrology. Of these patients, 37 had more than 4 years of follow-up. Intravesical injection of 200 U of onabotulinumtoxinA (Botox, Allergan, Irvine, California, USA) from August 2015 to June 2019. All patients received Botox injections. The intravesical injections of Botox were performed at 30 different sites of the bladder wall, excluding the trigone. The patients were randomly classified into three groups. Group one received onabotulinumtoxinA only, and group two received onabotulinumtoxinA and propiverine hydrochloride; group three received onabotulinumtoxinA and placebo. Eighty-nine patients completed the study. Results In our study, the decreased urgency-incontinence episodes per 24 h in the GII were significantly greater than in GI and GIII (P < 0.00001). The average decrease in the number of urgency-incontinence episodes per 24 h in GI was from 2.57 to 1, in GII from 3.12 to 0.55, and in GIII from 3.42 to 1.28. The average Urgency score decreased from 2.69 to 1.78. Also, the decrease in average Urgency score was from 2.64 to 1.93 when propiverine in GII was added and from 2.31 to 1.91 when placebo was added in GIII. The average cystometric capacity was increased from 240.43 to 329 ml in GI, from 252.64 to 351.83 in GII, and from 231.2 to 317.4 ml in GIII. Conclusion OnabotulinumtoxinA combined therapy with propiverine in female refractory overactive-bladder syndrome is considered as one of the options for a third-line treatment even if the efficacy of onabotulinumtoxinA is insufficient.

Keywords

detrusor overactivity, onabotulinumtoxinA, overactive bladder, propiverine, urgency incontinence, urgency

Recommended Citation

Gamal Eldin, Abourjila A.; Gabr, Ayman M.; and Elsofy, Amr M. (2023) "Comparative assessment of the efficacy of onabotulinumtoxinA as monotherapy and combined therapy with propiverine in female refractory overactive-bladder syndrome," Journal of Medicine in Scientific Research: Vol. 6: Iss. 2, Article 7.
DOI: https://doi.org/10.59299/2537-0928.1014