Intradetrusor injection of botulinum-A toxin in patients with idiopathic and neurogenic detrusor overactivity: urodynamic outcome and patient satisfaction.

Objective: To assess and compare the efficacy of botulinum-A toxin (BTX-A) injections into the detrusor in idiopathic and neurogenic detrusor overactivity (IDO and NDO) resistant to anticholinergic treatment with respect to patient satisfaction.

Methods: In a prospective study, 16 patients with IDO and 14 with NDO resistant to anticholinergic treatment were injected with 500 U of Dysport into the detrusor. Clinical, urodynamic, and satisfaction assessments were performed at baseline and after BTX-A injections.

Results: In IDO as well as in NDO, there was a significant increase in median maximum cystometric capacity (MCC) from 177.5 to 262.5 ml (P<0.0005) and 160 to 270 ml (P=0.001), median bladder compliance from 24.5 to 40.0 ml/cmH2O (P<0.0005) and 25.5 to 44.0 ml/cmH2O (P=0.001) and median PVR from 15 to 80 ml (P=0.001) and 15.0 to 62.5 ml (P=0.001), respectively. Median Pdet max decreased significantly from 49 to 37 cmH2O (P<0.0005) and 48.5 to 37.0 cmH2O (P=0.001), and median Pdet Qmax from 32.0 to 20.0 ml/sec (P<0.0005) and 36.0 to 21.5 ml/sec (P=0.001), respectively. The effect of BTX-A injections lasted for a median time of 5 months in both groups. Median daytime frequency, nocturia, and number of used pads decreased significantly in both groups. More than 80% of the patients were satisfied with the effect of BTX-A.

Conclusions: Patients with intractable IDO respond to intradetrusor BTX-A with a significant and comparable but temporally limited effect in urodynamic and LUTS parameters as those with NDO. The majority of patients were satisfied with treatment.