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Abstract

Objective:

The objective of this article is to determine treatment outcomes and risk factors for urinary retention in men with idiopathic overactive bladder (OAB) symptoms treated with intravesical botulinum toxin A (BTXA).

Patients and methods:

All men undergoing intravesical BTXA treatment from 2009 to 2013 at the Royal Berkshire Hospital were identified. Pre-treatment urodynamics and outcomes of treatment were determined.

Results:

A total of 35/43 men were deemed to have idiopathic OAB. Symptomatic improvement was seen in six of 13 (46%) dry OAB and 12/22 (55%) wet OAB irrespective of proven detrusor overactivity. Catheterisation rates were dose dependent with an overall rate of 16/35 (46%). Four of nine (44%) with bladder outflow obstruction required catheterisation, as did eight of 17 (47%) without. Twelve of 25 (48%) men with a Bladder Contractility Index (BCI) ⩽120 required catheterisation, as did four of 10 (40%) with a BCI >120.

Conclusion:

BTXA is a successful treatment in males with idiopathic wet and dry OAB, irrespective of detrusor overactivity. One hundred units is an appropriate dose at which to begin treatment. Surprisingly, presence of bladder outflow obstruction and weak bladder contractility did not demonstrate an increased risk for catheterisation although further study should be conducted with larger numbers of patients.

Keywords

Botulinum toxin overactive bladder detrusor overactivity urodynamics Botox

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References

Pannek

Stöhrer

Blok

. Guidelines on neurogenic lower urinary tract dysfunction. European Association of Urology (EAU) March 2011 update, http://www.uroweb.org/gls/pdf/19_Neurogenic_LR%20II.pdf (accessed: September 2013).

Schurch

de Sèze

Denys

. Botulinum toxin type A is a safe and effective treatment for neurogenic urinary incontinence: Results of a single treatment, randomized, placebo controlled 6-month study. J Urol 2005; 174: 196–200.

Kuo

Liao

Chung

. Adverse events of intravesical botulinum toxin A injections for idiopathic detrusor overactivity: Risk factors and influence on treatment outcome. Eur Urol 2010; 58: 919–926.

Abrams

. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: Three simple indices to define bladder voiding function. BJU Int 1999; 84: 14–15.

Griffiths

Höfner

Van Mastrigt

. Standardization of terminology of lower urinary tract function: Pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol Urodyn 1997; 16: 1–18.

Schäfer

. Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: From complex to simple. World J Urol 1995; 13: 47–58.

Lucas

Bedretdinova

Bosch

JLHR

. Guidelines on urinary incontinence. EAU April 2014 update, http://www.uroweb.org/gls/pdf/20%20Urinary%20Incontinence_LR.pdf (accessed May 2014).

Sahai

Sangster

Kalsi

. Assessment of urodynamic and detrusor contractility variables in patients with overactive bladder syndrome treated with botulinum toxin-A: Is incomplete bladder emptying predictable? BJU Int 2008; 103: 630–634.

Dmochowski

Chapple

Nitti

. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: A double-blind, placebo controlled, randomized, dose ranging trial. J Urol 2010; 184: 2416–2422.

10.

Smith

Chancellor

. Simplified bladder botulinum-toxin delivery technique using flexible cystoscope and 10 sites of injection. J Endourol 2005; 19: 880–882.

Results of intravesical botulinum toxin A in men with idiopathic overactive bladder symptoms