Urinary Incontinence

Botulinum Toxin A (BTX-A) in refractory non-neurogenic overactive bladder: A prospective review of intermediate-term quality of life outcome assessment

  • ERIC CHUNG
  • BOON CHEOK LEE
  • VINCENT TSE
  • JEREMY DE LEON
  • LEWIS CHAN

Pelviperineology 2011;30(3):81-83

Objective:

To evaluate the efficacy of BTX-A in non-neurogenic (idiopathic) overactive bladder (OAB) patients

Materials and methods:

All drug refractory non-neurogenic OAB patients that received intravesical BTX-A between January 2004 and January 2009 were recruited prospectively. Patient demographics, voiding diary and urodynamics studies were recorded. King’s Health Questionnaires (KHQ) was completed pre and post therapy at 3, 6 and 9 months. The primary end point assessments were number of urgency and urge incontinence as well as quality of life outcomes. All adverse events were also documented.

Results:

A total of 60 patients (28 men, 32 women) with the mean age of 64.2 (28 to 84) years old and a mean follow up was 26.2 (12 to 58) months, were recruited during the 5 years period. No significant adverse side effects or mortality were documented. Three patients (6%) developed a temporary increase in post void residuals requiring short-term catheterisation (< 5 days). Fifty patients (83%) demonstrated significant improvement with regards to their KHQ scores pre and post BTX administration (p < 0.001), with the symptomatic benefits diminishing at subsequent 6 and 9 months follow up (p>0.05). 48 patients (80%) reported recurrence of OAB symptoms at the 6 months follow up visit, necessitating reintroduction of anticholinergic therapy for symptomatic control. When looking at specific KHQ domains, significant reduction was noted in storage symptoms specifically of frequency, nocturia, urge and urge incontinence (p < 0.001). The improvement in stress incontinence and bladder pain were not significant (p>0.05). The functional bladder capacity increased from 192.7 (60 to 300) mls to 341 (140 to 550) mls while the number of pad use decreased from 3.7 (3 to 7) pads to 0.75 (0 to 1) pad (p < 0.001).

Conclusion:

Our results indicate that BTX-A treatment for non-neurogenic OAB appears to be safe and well-tolerated with most patients electing for repeated treatments.

Keywords: Overactive bladder; Intravescical BTX-A; Urge incontinence; Stress incontinence.