Abobotulinum - a toxin injection in patients with refractory idiopathic detrusor overactivity: injections in detrusor, trigone and bladder neck or prostatic urethra, versus detrusor - only injections

Emami, Maryam; Shadpour, Pejman; Kashi, Amir H.; Choopani, Masoud; Zeighami, Mohammadreza

doi:10.1590/S1677-5538.IBJU.2016.0622

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Original Article • IBJUInt. braz j urol 43 (6) • Nov-Dec 2017 • https://doi.org/10.1590/S1677-5538.IBJU.2016.0622 copy

Abobotulinum - a toxin injection in patients with refractory idiopathic detrusor overactivity: injections in detrusor, trigone and bladder neck or prostatic urethra, versus detrusor - only injections

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To evaluate if the injections of abobotulinum-A toxin in trigone and bladder neck/prostatic urethra in addition to detrusor provides better symptoms relief and urodynamic findings in patients with idiopathic detrusor overactivity (IDO) refractory to medical treatment.

Materials and Methods:

A total of 74 patients with IDO refractory to anticholinergics received injections in detrusor, trigone and bladder neck/prostatic urethra (Group A, N=36) versus detrusor only injections (Group B, N=38) of abobotulinum-A toxin. All patients were evaluated by a standard overactive bladder symptom score (OABSS) questionnaire and cystometrography before and 6 weeks after the operation. OABSS questionnaire was also completed 20 weeks after the operation.

Results:

The magnitude of OABSS reduction from baseline to 6 weeks after operation in groups A and B patients was 13.4±2.2 versus 11.7±2.1 (p=0.001). Cystometry results were similar in both groups except for higher volume at urgent desire to void in Group B patients (p <0.001). The mean±SD change in residual volume in Group A at 6 weeks after the operation was −4.8±28.6mL (p=0.33) compared to 21.3±16.9mL in Group B patients (p <0.001).

Conclusions:

In patients with IDO, adding trigone, and bladder neck/prostatic urethra as sites of abobotulinum- A toxin injection produces greater reductions in OABSS score and less residual urine volume but a lower volume at urgent desire to void in comparison with detrusor only injections.

Keywords:
Urinary Bladder; Overactive; Botulinum Toxins

		Group A^* * Detrusor, trigone, bladder neck/prostatic urethra including injections	Group B^ Detrusor only injections	P-value
Number of patients		36	38
Age, years; mean±SD		39.1±14.4	39.0±14.0	0.99
Total OABSS
	Baseline, mean (range)	22.3 (17–28)	21.8 (18–26)	0.41
	6 weeks, mean (range)	8.9 (–14)	10.1 (8–14)	0.006
	Compared to baseline (P value)	<0.001	<0.001
	20 weeks, mean (range)	10.9 (8–17)	13.4 (9–17)	<0.001
	Compared to baseline (P value)	<0.001	<0.001

		Group A^* * Detrusor, trigone, bladder neck/prostatic urethra including injections	Group B^ Detrusor only injections	P-Value
MCC, mL; Mean (range)
	Before injection	224.44 (160–400)	284.59 (160–520)	0.61
	6 week after injection	385.69 (280–490)	409.82 (290–530)	0.11
	P-value (6 week to baseline)^* ***** Within Group p-value: Comparison cyctometric varaibles 6 weeks after injections with values before injection	0.08	0.07
MDP, cm H₂O; Mean (range)
	Before injection	39.9 (14–63)	40.56 (17–73)	0.86
	6 week after injection	14.75 (6–29)	16.3 (7–30)	0.53
	P-value (6 week to baseline)^* ***** Within Group p-value: Comparison cyctometric varaibles 6 weeks after injections with values before injection	0.8	0.9
VUDV, mL; Mean (range)
	Before injection	211.45 (110–360)	205.68 (134–310)	0.73
	6 week after injection	334.13 (200–456)	363.93 (254–476)	0.02
	P-value (6 week to baseline)^* ***** Within Group p-value: Comparison cyctometric varaibles 6 weeks after injections with values before injection	<0.001	<0.001
VFUV, mL; Mean (range)
	Before injection	175.59 (100–330)	164.21 (110–290)	0.49
	6 week after injection	288.06 (200–450)	298.24(200–404)	0.32
	P-value (6 week to baseline)^* ***** Within Group p-value: Comparison cyctometric varaibles 6 weeks after injections with values before injection	0.1	0.08
PVR, mL; Mean (range)
	Before injection	64.6 (20–140)	69.3 (20–170)	0.61
	6 week after injection	60.8 (43–920)	90.6 (44–190)	<0.001
	P-value(6 week to baseline)^* ***** Within Group p-value: Comparison cyctometric varaibles 6 weeks after injections with values before injection	0.33	<0.001

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[1] Correspondence address: Pejman Shadpour, MD, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran Vanak Sq, Tehran 19697, Iran. Fax: +98 21 8864-4447 E-mail: shadpour.p@iums.ac.ir