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Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: do we need urodynamic investigation for outcome assessment?

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  • معلومة اضافية
    • المصدر:
      Publisher: Blackwell Science Country of Publication: England NLM ID: 100886721 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-410X (Electronic) Linking ISSN: 14644096 NLM ISO Abbreviation: BJU Int Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: Oxford, UK : Blackwell Science, c1999-
    • الموضوع:
      Botulinum Toxins, Type A/*therapeutic use ; Urinary Bladder, Neurogenic/*drug therapy ; Urinary Bladder, Overactive/*drug therapy ; Urinary Incontinence/*drug therapy; Botulinum Toxins, Type A/administration & dosage ; Botulinum Toxins, Type A/pharmacology ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Urinary Bladder, Neurogenic/physiopathology ; Urinary Bladder, Overactive/physiopathology ; Urinary Incontinence/physiopathology ; Urodynamics/drug effects
    • نبذة مختصرة :
      Objective: To evaluate if urinary continence in patients with refractory neurogenic detrusor overactivity (NDO) incontinence after intradetrusor onabotulinumtoxinA injections is sufficient for appropriate outcome assessment or if urodynamic investigation (UDI) is needed.
      Patients and Methods: A consecutive series of 148 patients undergoing intradetrusor onabotulinumtoxinA injections for refractory NDO incontinence were prospectively evaluated. Patients underwent UDI before and at 6 weeks after onabotulinumtoxinA injections. The primary outcome was the prevalence of maximum storage detrusor pressure (Pdet max storage) of >40 cmH 2 O in continent patients at 6 weeks after treatment. The secondary outcomes were treatment effects on other clinical and video-urodynamic variables.
      Results: At 6 weeks after intradetrusor onabotulinumtoxinA injections, 98 of the 148 patients (66%) with NDO incontinence were continent. Of these patients, 18 (18%, confidence interval 12-27%) had a Pdet max storage of >40 cmH 2 O. Gender, underlying neurological disorder, and high Pdet max storage before treatment appear to increase the risk of poor urodynamic outcomes.
      Conclusions: Urinary continence is not sufficient for outcome assessment after intradetrusor onabotulinumtoxinA injections, as high intravesical pressures threatening the upper urinary tract may be missed in a relevant proportion of continent patients. Therefore, we strongly recommend UDI as a routine part of the follow-up.
      (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)
    • Contributed Indexing:
      Keywords: intradetrusor onabotulinumtoxinA injections; neuro-urology; neurogenic detrusor overactivity; neurogenic lower urinary tract dysfunction; outcome assessment; urodynamic investigation
    • الرقم المعرف:
      EC 3.4.24.69 (Botulinum Toxins, Type A)
    • الموضوع:
      Date Created: 20170804 Date Completed: 20171204 Latest Revision: 20181202
    • الموضوع:
      20221213
    • الرقم المعرف:
      10.1111/bju.13976
    • الرقم المعرف:
      28771936